![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 6 to 30 of 30. Go back in thread:
Posted by bob on January 19, 2002, at 13:48:55
In reply to MAOI efficacy » SLS, posted by TSA West on January 19, 2002, at 5:14:19
If Nardil is associated with intrinsic sedation, then why do so many people complain of insomnia on that med?
Posted by bob on January 19, 2002, at 13:55:25
In reply to Mood-reactivity in atypical depression., posted by SLS on January 19, 2002, at 0:25:05
Nardil seems to be quite a paradox to me. It is highly indicated (as are the MAOIs in general) for atypical depression. Atypical depression has as one of its features, hyperphagia. Isn't Nardil notorius for causing weight gain and extreme carb cravings? How can this be helpful for hyperphagia?
Posted by [email protected] on January 19, 2002, at 14:30:32
In reply to MAOI efficacy » SLS, posted by TSA West on January 19, 2002, at 5:14:19
Hi,
I think it still holds that MAOI's are superior for aytpical depression
Nowadays polypharmacy is common so more alternatives exist.
Still, I think enhanced steady state dopamine enhancement reduces fear, passivity, pain, introversion, low energy, and anhonesia (sp? - ie; lack of pleasure).In my opinion the nice thing about MAOI's especially low dose Eldepryl is:
- Robust pro-dopamergic action
- Steady state effect
- Dopaminergic neuroprotection
- Delay Parkinson's onset (SP more likely to get Parkinson's)
- For atypicals / phobics / bipolar lows, great "base" to add to, preventing an otherwise susceptibility to sedation and sexual side effects.Hope that made a bit of sense! :)
kreg park
The 3 MAOI's Nardil, Eldepryl, Parnate, have different profiles so if Nardil is too sedating than Parnate, or high dose Elderpyl can be tried.
Most people will probably find Nardil quite activating.> I wish you well.
>
> I think you're on the right track with MAOIs in general, considering that you had a response to Nardil in the past.
>
> And further, your 'rejection-sensitivity' sounds a lot like Social Anxiety Disorder (a specific disorder ameliorated most effectively by MAOIs).
>
> Selegiline (MAOI-B) could provide you some relief from the intrinsic sedation of the Nardil (http://www.dr-bob.org/tips/split/Selegiline-for-depression.html).
>
> 60 mg of selegiline is the equivalent of 30 mg of Nardil, according to one of Dr. Bob's associates.
>
> I am glad that you have progressed in the learning of your emotions, such that you can present them to us-- and thus we can help you more thoroughly in your quest for a good medication regimen....
>
> TSA West^^^^^^^^^
Posted by bob on January 19, 2002, at 14:42:30
In reply to Re: MAOI efficacy » TSA West, posted by [email protected] on January 19, 2002, at 14:30:32
SP = Social Phobic?
If so, there is actually evidence that social phobics develop Parkinsons more often?
Posted by bob on January 19, 2002, at 14:45:13
In reply to Re: MAOI efficacy » TSA West, posted by [email protected] on January 19, 2002, at 14:30:32
Yet another question:
How can an antidepressant, like the MAOIs etc. increase dopamine levels, without the risk of EPS? I thought that was exactly why APs inclined to do that.
Posted by JohnX2 on January 21, 2002, at 1:57:34
In reply to Mood-reactivity in atypical depression., posted by SLS on January 19, 2002, at 0:25:05
Hi Scott,Sorry you feel crummy.
Did you every get to try the Topamax + Lamictal
experiment?Mine is going very well.
I am taking:
400 mg Topamax
150 mg Lamictal
2.5 mg Klonopin
5 mg ZyprexaThe Topamax addition FIXED my myofacial pain.
Plus it seems to have MOPPED UP any residual
depression. Plus I seem to have noticed that I
DON'T HAVE stimulant tolerance issues. Plus
I can take meds that would cause myofacial pain
in the past (Wellbutrin), etc.....worth a try.
I think the Topamax works well as an adjunct
to Lamictal, but I'm not so sure how I would
do on it stand alone.
Good luck,
John
> Hi folks.
>
> Not doing so well...
>
> So, what else is new?
>
> I thought the study citation I included below was important to take a look at.
>
> I have often questioned the definition and characterization of "mood-reactivity". It has been a source of confusion in my attempts to accurately describe to clinicians (especially with the folks at Columbia Presbyterian) how I experience depression so that they may better evaluate my case. Hypersomnia and hyperphagia (both considered reverse-vegetative features), leaden-paralysis, and rejection-sensitivity have been consistent and defining features of my presentation. That I have been most responsive to MAO-inhibitors, particularly Nardil, would be corroborative with these features in characterizing my depression as being of the "atypical" type. However, I have never felt that the essential nature of my depressive state as I experience it has been qualitatively reactive to any environmental stimuli. I am most probably bipolar, as I have experienced manic reactions to antidepressants, although mania has never occured spontaneously (this presentation has been proposed to be included in the future DSM V diagnostic schema as Bipolar III). Based upon my experience, I would conclude that either:
>
> 1. Bipolar depression looks similar to atypical unipolar depression but lacks the mood-reactivity putatively intrinsic to atypical depression.
>
> 2. Mood-reactivity is not an essential characteristic of either illness.
>
>
> Gabitril looks interesting. I extend my appreciation to those who have shared their experiences with it, along with everyone else for their valuable presence here on PB.
>
>
> Always Yours,
>
> Scott
>
>
> -----------------------------------------------------
>
>
> Mood Reactivity Rejected As Symptom Of Depression Subtype
>
> Archives of General Psychiatry
>
> 01/16/2002 By Elda Hauschildt
>
> Mood reactivity may not be a valid component of the atypical features subtype of major depressive disorder.
>
> Four other symptoms of the subtype listed in the Diagnostic & Statistical Manual of Mental Disorders-IV (DSM-IV) are modestly associated with the subtype, United States researchers say. These include hypersomnia, hyperphagia, leaden paralysis and rejection sensitivity.
>
> Investigators from Brown University in Providence, Rhode Island suggest that mood reactivity should "perhaps be dropped from the diagnostic criteria set."
>
> They examined the five major atypical features using data on the first 579 psychiatric outpatients evaluated in the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project.
>
> Participants all had a current diagnosis of major depressive disorder. A total of 130 patients had atypical features and 449 did not.
>
> "Our most salient finding regards mood reactivity," the researchers explain. "Mood reactivity has been considered an essential component of the atypical features subtype; of the five atypical symptoms, it is the only one required to make the diagnosis.
>
> "Consistent with other reports, we did not find any evidence to suggest that mood reactivity is associated with the atypical B symptoms."
>
> Investigators also point out that their correlation analyses revealed significant but modest associations for the other four atypical symptoms.
>
> "Although correlation coefficients of 0.09 to 0.10 account for only about 1 percent of the variance, the association between insomnia and decreased appetite was only slightly higher.
>
> "This suggests that this level of correlation may be clinically meaningful.
>
> "Our analyses lend support to the discriminant validity of the subtype because hyperphagia and hypersomnia were generally more closely related with the remaining atypical symptoms than were the non-atypical symptoms of decreased appetite and insomnia."
>
> They obtained detailed demographic and clinical information for each patient in semi-structured interviews. They then made a series of a priori hypotheses about how depressed patients with atypical features would differ from those without the features.
>
> Hypotheses were that depressed patients with atypical features would be more likely than non-atypical depressed patients to exhibit: female sex, younger age, longer episode duration, younger age at onset, amphetamine abuse or dependence, histrionic and avoidant personality disorders and higher rates of bipolarity, milder illness, greater comorbidity with panic attacks, agoraphobia, social phobia, hypochondriasis, bulimia, and body dysmorphic disorder.
>
> "Although many of the predicted hypotheses were substantiated, an equal number were not," investigators report.
>
> "Three of the most commonly cited validators of atypical depression were confirmed in our study: a preponderance of women, a younger age at onset, and a longer duration of illness.
>
> "Two other important validators were not confirmed. Depressed patients with atypical features were not younger and they were found to be more rather than less severely depressed."
>
> Archives of General Psychiatry, 2002; 59: 70-76.
Posted by [email protected] on January 21, 2002, at 2:16:39
In reply to Re: MAOI efficacy » [email protected], posted by bob on January 19, 2002, at 14:45:13
Hi Bob,
(Some people use SP short for Social Phobia).
Yes, it has been well established in studies that Parkinson's patients are five times more likely to have have SP *precede* development of Parkinson's.
Yes also the dopamine point you brought out. Parkinson's meds don't usually work as antidepressants.
However MAOI's (including Elderpyl at high dose) also significantly boost serotonin and norepineprhine.
Nardil boost serotonin more than dopamine and norepihephrine (and also GABA at higher doses).kp
> Yet another question:
>
> How can an antidepressant, like the MAOIs etc. increase dopamine levels, without the risk of EPS? I thought that was exactly why APs inclined to do that.
Posted by SLS on January 21, 2002, at 14:12:53
In reply to Re: Mood-reactivity in atypical depression. » SLS, posted by JohnX2 on January 21, 2002, at 1:57:34
Thanks so much for your post, John.
I will definitely keep Topomax in mind, then. My doctor brought up its use early in my treatment with him, but I don't know if he meant to use it as a supplement. I'm sure he would have kept the Lamictal on-board anyway, as it is one of the only drugs that makes a dent in an otherwise inpenetrable wall. That Topomax has enhanced your response to stimulants is exciting. I think I'll make sure to try it before giving up on Effexor.What side effects do you notice with Topomax? In particular, what cognitive effects do you experience? Have they mitigated with time. The current posture on this issue is that a gradual titration can almost prevent the emergence of cognitive side effects and increase the chances of their eventual disappearance. How did you go about starting Topomax?
In re: Zyprexa. I seem to suffer a zombie-like cognitive blunting after reaching 5.0mg for several days. Risperdal and Geodon too. Do you have any thoughts on this? The thing that confuses me is that I tolerated Zyprexa 10mg well for a week or so a few years ago. At the time, it was used to put out a manic brush-fire. Maybe there is some sort of time-dependency involved in the emergence of this effect. Any thoughts? Otherwise, these atypical neuroleptics show signs of being particularly beneficial to me.
Currently:
Lamictal - 300mg
Effexor - 300mg
imipramine - initially, titrating to 200mg
(It is likely that IMI blood levels will be increased due to the interaction of Effexor with CYP450. Otherwise, 300mg will be the eventual target)
BTW, What are your thoughts on Gabitril?I am SO glad that things are progressing splendidly for you. I was concerned for awhile when your name on PB was appearing less frequently.
HAVE FUN!!! Enjoy every moment of it.
Thanks again for your input.
Sincerely,
Scott> Hi Scott,
>
> Sorry you feel crummy.
>
> Did you every get to try the Topamax + Lamictal
> experiment?
>
> Mine is going very well.
>
> I am taking:
>
> 400 mg Topamax
> 150 mg Lamictal
> 2.5 mg Klonopin
> 5 mg Zyprexa
>
> The Topamax addition FIXED my myofacial pain.
> Plus it seems to have MOPPED UP any residual
> depression. Plus I seem to have noticed that I
> DON'T HAVE stimulant tolerance issues. Plus
> I can take meds that would cause myofacial pain
> in the past (Wellbutrin), etc.....worth a try.
> I think the Topamax works well as an adjunct
> to Lamictal, but I'm not so sure how I would
> do on it stand alone.
>
>
Posted by djmmm on January 21, 2002, at 14:33:54
In reply to Re: MAOI efficacy » bob, posted by [email protected] on January 21, 2002, at 2:16:39
> Hi Bob,
>
> (Some people use SP short for Social Phobia).
> Yes, it has been well established in studies that Parkinson's patients are five times more likely to have have SP *precede* development of Parkinson's.can you post these abstracts, or a link, please...
I am aware of a D2 receptor connection (low D2 receptor binding in some people with social phobia)...PET scans of parkinsons patients show increased D2 binding (via the use of D2 agonists)...so Im a bit confused...
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1801535&dopt=Abstract
> Yes also the dopamine point you brought out. Parkinson's meds don't usually work as antidepressants.
> However MAOI's (including Elderpyl at high dose) also significantly boost serotonin and norepineprhine.
> Nardil boost serotonin more than dopamine and norepihephrine (and also GABA at higher doses).
>
> kp
>
>
> > Yet another question:
> >
> > How can an antidepressant, like the MAOIs etc. increase dopamine levels, without the risk of EPS? I thought that was exactly why APs inclined to do that.
Posted by JohnX2 on January 21, 2002, at 15:17:44
In reply to Re: Mood-reactivity in atypical depression. » JohnX2, posted by SLS on January 21, 2002, at 14:12:53
Hi Scott,Here is what is amazing about my reaction
to the cognitive side effects to Topamax:
ALMOST NONE!The 1st day the doctor gave it to me I took 25 mg.
He gave me another 25 mg but was afraid it may
make me drowsy. It didn't make me drowsy. It did
immediately fix any residual myofacial pain in a
manner identical to klonopin.We quickly bumped the dose to 200 mg. No dizziness,
blurred vision, stupor, etc. Just typical benzo
like side effects. I can't explain this phenomina.
Topamax works on glutamate at the AMPA receptor
and GABA at the GABA(A) receptor. But I seemed to
be getting side effects consistent only with
increased conductance at the GabaA receptor and
not goofing with the glutamate (which is where the
major cognitive crap comes in, I believe). So for
me Topamax acts more like a benzo than a
bad anti-convulsant. My doctor was really shocked
too, and we pumped up the dose really fast with
no difficulty.I asked people on this group if they tried Topamax
as an ADD-ON to Lamictal, and it seems as though
I am a guinea pig. So I know that Topamax is mediating
the AMPA glutamate receptors and these cascade intot
the NMDA glutamate receptors that Lamictal work
on and I'm wondering if the Lamictal sitting there
"banding" the NMDA receptors was some how preventing
the AMPA effects from causing cognitive side effects,
etc. I just don't know. That's why I think the
duo is an interesting combo.I was thinking that adding Acamprosate,
a GabaB agonist and mild NMDA antagonist would
make a trio bipolar knockout punch for me.
Just a muse.Good Luck.
John> Thanks so much for your post, John.
> I will definitely keep Topomax in mind, then. My doctor brought up its use early in my treatment with him, but I don't know if he meant to use it as a supplement. I'm sure he would have kept the Lamictal on-board anyway, as it is one of the only drugs that makes a dent in an otherwise inpenetrable wall. That Topomax has enhanced your response to stimulants is exciting. I think I'll make sure to try it before giving up on Effexor.
>
> What side effects do you notice with Topomax? In particular, what cognitive effects do you experience? Have they mitigated with time. The current posture on this issue is that a gradual titration can almost prevent the emergence of cognitive side effects and increase the chances of their eventual disappearance. How did you go about starting Topomax?
>
> In re: Zyprexa. I seem to suffer a zombie-like cognitive blunting after reaching 5.0mg for several days. Risperdal and Geodon too. Do you have any thoughts on this? The thing that confuses me is that I tolerated Zyprexa 10mg well for a week or so a few years ago. At the time, it was used to put out a manic brush-fire. Maybe there is some sort of time-dependency involved in the emergence of this effect. Any thoughts? Otherwise, these atypical neuroleptics show signs of being particularly beneficial to me.
>
> Currently:
>
> Lamictal - 300mg
> Effexor - 300mg
> imipramine - initially, titrating to 200mg
> (It is likely that IMI blood levels will be increased due to the interaction of Effexor with CYP450. Otherwise, 300mg will be the eventual target)
>
>
> BTW, What are your thoughts on Gabitril?
>
> I am SO glad that things are progressing splendidly for you. I was concerned for awhile when your name on PB was appearing less frequently.
>
> HAVE FUN!!! Enjoy every moment of it.
>
> Thanks again for your input.
>
>
> Sincerely,
> Scott
>
>
>
> > Hi Scott,
> >
> > Sorry you feel crummy.
> >
> > Did you every get to try the Topamax + Lamictal
> > experiment?
> >
> > Mine is going very well.
> >
> > I am taking:
> >
> > 400 mg Topamax
> > 150 mg Lamictal
> > 2.5 mg Klonopin
> > 5 mg Zyprexa
> >
> > The Topamax addition FIXED my myofacial pain.
> > Plus it seems to have MOPPED UP any residual
> > depression. Plus I seem to have noticed that I
> > DON'T HAVE stimulant tolerance issues. Plus
> > I can take meds that would cause myofacial pain
> > in the past (Wellbutrin), etc.....worth a try.
> > I think the Topamax works well as an adjunct
> > to Lamictal, but I'm not so sure how I would
> > do on it stand alone.
> >
> >
Posted by medlib on January 22, 2002, at 4:55:07
In reply to Mood-reactivity in atypical depression., posted by SLS on January 19, 2002, at 0:25:05
Hi Scott--
It's good to see you posting again! Sorry you're feeling down, but I'm glad that your "down" doesn't seem to be totally "DOWN". (I conclude this because 1) you're posting, and 2) your cognition is as intimidating as ever.)
The carousel horse I'm riding is up right now, but it's still going in circles. We seem to have so many similar symptoms that sometimes I think, "If Scott's been dxed BP and his manic episodes are solely drug-induced, maybe I'm BP, too." (Sorta sounds like intern hyperchondria, doesn't it?) I've cycled from "down" to "DOWN" and back since my early teens--all appropo of absolutely nothing. I had 2 days of "mini-mania" on Geodon, and earlier tonight I realized I'd just gone around a bend that wasn't there. Unfortunately, this insight didn't hit me until *after* I'd posted on PSB about the Dinka tribe of Sudan and the average height of Japanese over the last 10,000 years. Definitely time to cut back on the Wellbutrin. And then there's my descent into alliteration. Mark H. called it for me once when we were trading palindromes; he asked if my fascination with words was part of my disease. Since then, it's been a reliable (albeit peculiar) red flag for me.
The truth is, I've been so very different from others all of my life that it's difficult to know what of my behavior is a "mental illness" and what's just me. For example, when I asked my pdoc if he'd had any other patients who were put to sleep by Dexedrine, he said, dubiously, that a few ADDers had paradoxical reactions to stimulants. (But methylphenidate acts as a normal stimulant for me; only Dex and its cousin Adderall give a headache, then put me to sleep.) ADD? Me? Impulsive for me is going to the store *before* I run out of dog food. I couldn't multitask if my life depended on it; my transmission doesn't shift gears.
Ah, well. If I take too many more different drugs for too much longer, I won't have to worry about tripping over stray factoids; they will have joined my short-term memory in Never-Never Land. I began taking a second Wellbutrin SR 2 days ago--again. I had taken 2/day per pdoc's rx earlier in the month but d/ced the 2nd tab, and I truly couldn't remember why! I knew I'd be asked about it later this week, so...; *now* I remember. In between, I've been trying to up my Vasotec 50% per internist's rx; naturally, the increased bp med led to migraines and multiple naps. When I whined about all this to my daughter, she said, "Mother, why don't you just dump all that stuff and take Ecstasy? I'll send you some." It's beginning to sound like a reasonable alternative.
For this turn of the carousel, my psych-related meds include Effexor XR 375 mg., methylphenidate 20 mg. 3/day (I remember the 3rd dose only occasionally), Wellbutrin SR 150 mg., and Synthroid 0.15 mg. (You don't want to know about the rest.)
Why did you stop at 300 mg. Effexor? Do you know whether or not you metabolize CYPs normally?
I have to go fill out the incidence report Pfizer sent. (And it's been only 2 months since they received my complete report and inquiry! Guess it's a good thing I wasn't holding my breath waiting for assistance from *that* source.) Geodon didn't work for you either? I wonder how it's doing with schizophrenics; it hasn't exactly reached warp speed with Babblers, from what I've read so far.
More later, when I've returned to what's left of my senses. Take care---medlib
Posted by noa on January 22, 2002, at 17:14:52
In reply to Mood-reactivity in atypical depression., posted by SLS on January 19, 2002, at 0:25:05
Hi, Scott--
Sorry you are feeling lousy. The study is interesting--thanks for pointing it out. I hope you do find success on your next med trial.
Posted by IsoM on January 22, 2002, at 17:47:04
In reply to Re: The musical meds merry-go-round (looong) » SLS, posted by medlib on January 22, 2002, at 4:55:07
Medlib! ...and to me your story sounds like mine "except"... I know I'm not manic, but my highs on ADHD does seem manic to others at times. My doctor has looked side-ways at me a few times & asked if I felt manic. I'd laugh & say I could understand why but this is a 'normal' mood for me. If I'm happy, I'm hyper. I hope as the adrafinil settles into my system again (I finally got my order on Friday), I'll not act so squirrely.
You're fascinated by words??? Please say yes. I love words - such playthings. One son said he wished he could get a degree in etymology & just teach & research words. I keep my big, thick dictionary beside me always.
I really dislike being labeled with 'this or that' but sometimes it does help in understanding a person's condition. What have you got? Bipolar and/or? I know my hypomania isn't real as I never leave the ground, I'm always still grounded & will tire out later in the day. When night comes, I can sleep lots too.
Your comment "I won't have to worry about tripping over stray factoids; they will have joined my short-term memory in Never-Never Land." is like me. I have people say 'oh, we all get forgetful' but not like I do. I swear somedays I spend 1/3 of my time wandering about looking for things I either placed in a safe sensible spot (which never comes to mind) or just misplaced a minute or two ago with no idea where I put it down. My sons have said so many times "But I just explained that to you" or "But I checked with you & you said yes".
Short-term memory? What's that. Same with working memory. In order to think some things through, one needs to keep a list of ideas in their mind. But by the time I'm trying to think out the fourth thing, my mind's chucked out thought #1 to make room for thought #4. It becomes impossible to think something through at times. Thank goodness, adrafinil gives me more brain RAM. Like getting a whole new hard-drive & fast CPU! (Now if I could only get a 'search' feature).
Dexedrine can sometimes put me to sleep too, sometimes wakes me up. It seems that if I'm so sleepy that I go to bed before the Dex really kicks in, I'll sleep through it all. If I can force myself to keep going, when the Dex does kick in, I'll wake up most times. No longer using it since I have adrafinil. Adrafinil works better, longer-term & much, much smoother. Still can sleep easily at night too. Ritalin was just too up & down for me. When the dose wore off, I'd be so sleepy again, in a matter of minutes.
You also said "The truth is, I've been so very different from others all of my life that it's difficult to know what of my behavior is a "mental illness" and what's just me."
I used to sit outside at night as a teenager & look at the stars wondering which star was home & why I got left here. Seriously.
I know better now & while I'm glad my mind's working well again, I have sometimes felt very alone. I've never met a friend (as dear as my friends are to me) who had the unusual interests in so many things as I do. And people tend to get boring & tedious as they become adults. They've totally how to be children & what it feels like. It's so sad.Anyways, I've blithered on endlessly now & Dr. Bob's probably going to find a hacker to get into my computer to disable it just to shut me up. (just kidding.) But I'm curious to know more about your diagnoses & your interests.
JudyJust a little extra.
I never, ever would've thought of myself as impulsive. Like you, I tend to run out of things. I've never bought anything impulsively in my life that I remember. But impulsiveness can show in different ways. I tend to get very enthusiastic about something & have a strong tendency to blurt out what's on my mind (not nasty stuff - just getting real involved & wanting to sound out my ideas too). That's impulsiveness too. It's taken a lot of self-control, maturity, & SSRIs to temper that impulse. I've gotten much better but will still forget myself in a group sometimes. I surprise people often but very few are offended, I guess 'cause I don't say mean things, just weird stuff.(Wheww!) Just a little extra?
Really, this isn't hypomania. :)
Posted by Chris A. on January 23, 2002, at 1:37:07
In reply to Re: The musical meds merry-go-round (looong) » SLS, posted by medlib on January 22, 2002, at 4:55:07
Tried to start a new thread, but my computer says "no."
What's the procedure for filing an incidence report with a pharmaceutical company? Is it worth the effort to left them know of adverse events? I also had a lot of hopes for Geodon, but the akathisia dashed those.
Do you know anything about filing incidence reports with the makers of ECT machines? Do they just get trashed?I don't have a legal bone in my body, but somehow feel someone needs to know that adverse events affect real people.
Perhaps better meds and better treatments will emerge if we speak up. Dream on.Thanks,
Chris A.
P.S. Good to see you posting, Scott
> I have to go fill out the incidence report Pfizer sent. (And it's been only 2 months since they received my complete report and inquiry! Guess it's a good thing I wasn't holding my breath waiting for assistance from *that* source.) Geodon didn't work for you either? I wonder how it's doing with schizophrenics; it hasn't exactly reached warp speed with Babblers, from what I've read so far.
Posted by bob on January 23, 2002, at 1:44:11
In reply to Re: The musical meds - incidence report » medlib, posted by Chris A. on January 23, 2002, at 1:37:07
What kind of incidence report were you going to file with makers of ECT machines?
I too had severe akathisia with Geodon.
Posted by Chris A. on January 23, 2002, at 2:17:23
In reply to Re: The musical meds - incidence report » Chris A., posted by bob on January 23, 2002, at 1:44:11
> What kind of incidence report were you going to file with makers of ECT machines?
"Minor cognitive impairment," similar in pattern to that normally found in chronic epilepsy. Need I say more? That's a near quote from the report of my rather extensive neuropsych testing a year ago. Actually, it's very difficult to say more since I no longer have command of the English language.
It has all been very humbling and painful, as intelligence is over-valued where I come from.Chris A.
Posted by bob on January 23, 2002, at 2:24:53
In reply to Re: The musical meds - incidence report, posted by Chris A. on January 23, 2002, at 2:17:23
> > What kind of incidence report were you going to file with makers of ECT machines?
>
> "Minor cognitive impairment," similar in pattern to that normally found in chronic epilepsy. Need I say more? That's a near quote from the report of my rather extensive neuropsych testing a year ago. Actually, it's very difficult to say more since I no longer have command of the English language.
> It has all been very humbling and painful, as intelligence is over-valued where I come from.
>
> Chris A.-------------------------------------------------
I assume you are attributing your loss of command of the English language to ECT treatments?
If you don't mind me asking, how many did you have, and were they unipolar, or bipolar?
Posted by djmmm on January 23, 2002, at 13:17:48
In reply to Re: The musical meds - incidence report » medlib, posted by Chris A. on January 23, 2002, at 1:37:07
> Tried to start a new thread, but my computer says "no."
>
> What's the procedure for filing an incidence report with a pharmaceutical company? Is it worth the effort to left them know of adverse events? I also had a lot of hopes for Geodon, but the akathisia dashed those.
> Do you know anything about filing incidence reports with the makers of ECT machines? Do they just get trashed?
>
> I don't have a legal bone in my body, but somehow feel someone needs to know that adverse events affect real people.
> Perhaps better meds and better treatments will emerge if we speak up. Dream on.
>
> Thanks,
>
> Chris A.
>
> P.S. Good to see you posting, Scott
>
> > I have to go fill out the incidence report Pfizer sent. (And it's been only 2 months since they received my complete report and inquiry! Guess it's a good thing I wasn't holding my breath waiting for assistance from *that* source.) Geodon didn't work for you either? I wonder how it's doing with schizophrenics; it hasn't exactly reached warp speed with Babblers, from what I've read so far.
The easiest way to report any adverse reaction and/or problem would be through the FDA's MEDWATCH program...you can access them directly via the internet.https://www.accessdata.fda.gov/scripts/medwatch/
or you can contact the FDA Office of Emergency Operations: 301-443-1240
Posted by Chris A. on January 23, 2002, at 19:59:19
In reply to Re: The musical meds - incidence report » Chris A., posted by bob on January 23, 2002, at 2:24:53
> I assume you are attributing your loss of command of the English language to ECT treatments?Not necessarily, but they sure didn't help. I haven't ever had seizures. My neurologist sees nothing to indicate that there's ever been one outside of ECT.
>
> If you don't mind me asking, how many did you have, and were they unipolar, or bipolar?Fifty total, four different times during a 23 year time span. About half were bilateral and the other half unilateral.
Chris A.
Posted by medlib on January 23, 2002, at 20:32:21
In reply to Re: The musical meds - incidence report » medlib, posted by Chris A. on January 23, 2002, at 1:37:07
Hi Chris--
My pdoc asked the local sales rep to contact the Geodon researchers. He wanted to see if they had any suggestions that would allow me to resume taking Geodon (minus the EPS). Though I never took more than the lowest dose twice a day, I'd experienced complete remission of my depressive symptoms (unlike any other rx I've tried)--before the EPS hit. Withdrawal, no matter how gradual, produced severe panic attacks (which *felt* life-threatening--the first one sent me to the ER with what they termed "false suffocation syndrome"). I'd never had an anxiety or panic attack, but these came twice a day (12 hours apart, like clockwork) each lasting 45min-1hr. for 10 days. It was like visiting heaven and hell both in the same month.
Since my response was so clearly idiosyncratic, and didn't result in hospitalization or permanent injury (the criteria for FDA-required reporting), I had no interest in making "official" contact with Pfizer. The Incidence Report form was their belated response to my pdoc's request for consultation; he passed it on to me. Since I can't envision either of them really giving a damn, I'll probably ignore both.
Drug companies have the highest profit margins of any industry world wide. The only entity with a prayer of making an impact on them is the FDA--and that threat is minimized by extensive "collaboration". I come from a family of attorneys and wouldn't dream of taking on such "deep pockets"--even with an iron-clad case.
From my viewpoint, the average healthcare consumer has about 3 options, s/he can say no, can fire his/her doc and/or can seek help in another country.
Re ECT: The manufacturers of ECT equipment, like those who make surgical devices, are liable only if their products fail to operate as specified. They have no other responsibility for patient outcomes; primary liability is assigned to those who order and/or administer the procedures--and then only to the degree that their actions deviate from standard medical practices.
Bottom line? There are no guarantees; "professionals" are paid for their time and services, not their results. Caveat emptor! Any wonder why more and more people are researching their own healthcare concerns?
Well wishes---medlib (now climbing down from the pulpit)
Posted by medlib on January 23, 2002, at 21:02:04
In reply to the Perpetual Cycle » medlib, posted by IsoM on January 22, 2002, at 17:47:04
Hi Judy--
Thanks for the reply! I'd suspected that we might have some things in common from reading (and enjoying!) a number of your earlier posts.
However, I think that I've probably exceeded my "pain-in-the-a**" quota from Dr. Bob with my recent unsolicited "helpful" suggestions and requests for duplicate post deletions, so I'd better move this to PSB before he does. I'll try to start a new thread there, if you don't mind.
Now relocating, Dr. Bob---medlib
Posted by SLS on January 23, 2002, at 21:05:18
In reply to Re: Rx incidence reports » Chris A., posted by medlib on January 23, 2002, at 20:32:21
> My pdoc asked the local sales rep to contact the Geodon researchers. He wanted to see if they had any suggestions that would allow me to resume taking Geodon (minus the EPS). Though I never took more than the lowest dose twice a day, I'd experienced complete remission of my depressive symptoms (unlike any other rx I've tried)--before the EPS hit. Withdrawal, no matter how gradual, produced severe panic attacks (which *felt* life-threatening--the first one sent me to the ER with what they termed "false suffocation syndrome"). I'd never had an anxiety or panic attack, but these came twice a day (12 hours apart, like clockwork) each lasting 45min-1hr. for 10 days. It was like visiting heaven and hell both in the same month.
Hi Medlib.I almost hate to post anything anymore. I can't really follow-up on them and feel that I am disappointing or discouraging people from replying. Hi Noa. I really do appreciate the support. I think Effexor has reduced my motivation and drive to participate here. In addition, the depression has been rather heavy lately. Emotional crap too. Maybe I'll post on Psycho-Social-Babble.
I addressed a post to you a month or two ago. An idea occurred to me when I was pondering your predicament. I don't remember what the hell it was, but I thought it to be pretty smart at the time. Of course, such delusions can readily be blamed on mental illness. :-)
Anyway, after reading your post here, I am wondering if you have investigated adding buspirone into any of your treatment regimes. Perhaps you could add it to Zyprexa or an SSRI/Effexor to reproduce some of the 5-HT1a agonism effected by Geodon. Also, if I'm 180 degrees wrong there, how about adding pindolol to Geodon so as to reduce EPS and the sympathetic "storms" that might be involved with your panic-attacks/false suffocation syndrome?
I admire your vigilence and lack of pessimism.
Until later...
- Scott
Posted by Chris A. on January 24, 2002, at 1:00:34
In reply to Re: The musical meds - incidence report, posted by djmmm on January 23, 2002, at 13:17:48
> The easiest way to report any adverse reaction and/or problem would be through the FDA's MEDWATCH program...you can access them directly via the internet.
>
> https://www.accessdata.fda.gov/scripts/medwatch/
>
> or you can contact the FDA Office of Emergency Operations: 301-443-1240
Thanks!Chris A.
Posted by Chris A. on January 24, 2002, at 2:05:45
In reply to Re: Rx incidence reports » Chris A., posted by medlib on January 23, 2002, at 20:32:21
> Hi Chris--
>
> My pdoc asked the local sales rep to contact the Geodon researchers. He wanted to see if they had any suggestions that would allow me to resume taking Geodon (minus the EPS). Though I never took more than the lowest dose twice a day, I'd experienced complete remission of my depressive symptoms (unlike any other rx I've tried)--before the EPS hit. Withdrawal, no matter how gradual, produced severe panic attacks (which *felt* life-threatening--the first one sent me to the ER with what they termed "false suffocation syndrome"). I'd never had an anxiety or panic attack, but these came twice a day (12 hours apart, like clockwork) each lasting 45min-1hr. for 10 days. It was like visiting heaven and hell both in the same month.It's amazing how we are all so different. My panic/akathisia immedicately subsided when we withdrew the Geodon. My pDoc hasn't mentioned trying to revisit it. Sorry you had to go through all of that.
> Drug companies have the highest profit margins of any industry world wide.Perhaps investing in Pfizer would cure us all :-)
>
> From my viewpoint, the average healthcare consumer has about 3 options, s/he can say no, can fire his/her doc and/or can seek help in another country.The big question then, is when to say "no." It seems like I have blown it on that one.
> Re ECT: The manufacturers of ECT equipment, like those who make surgical devices, are liable only if their products fail to operate as specified. They have no other responsibility for patient outcomes; primary liability is assigned to those who order and/or administer the procedures--and then only to the degree that their actions deviate from standard medical practices.I would really like to see complete neuro testing done on every patient that is able to complete it prior to ECT. There are factors that cause some of us to be at greater risk for permanent cognitive side effects. That risk could be graded to enable the patient to make a more informed decsion. How about neurological consults being required prior to administration of ECT? I guess there's no place to go where my concerns/ideas would be taken seriously. It is frustrating. Perhaps I should just talk openly with my pDoc about it. We are both a bit shy, but after 6 1/2 years I should be able to tell him what I am thinking. I am wondering if he has changed any pre-ECT evaluation procedures in his department. I don't believe in litigation because there's been a bad outcome. I would just like to see practice standards scrutinized and reviewed so that there will be fewer bad outcomes. That probably has to be done at the APA level when it applies to ECT.
Coming from a medical family I find almost impossible to criticize a doc. (Hubby probably wishes I'd apply that rule to him). They make tough calls everyday.>
> Bottom line? There are no guarantees; "professionals" are paid for their time and services, not their results. Caveat emptor! Any wonder why more and more people are researching their own healthcare concerns?I am really weary of trying to figure it out. My brain just can't think it through anymore. Pour on the Excelon!
>
> Well wishes---medlib (now climbing down from the pulpit)Some of us like it when you're in your pulpit - we learn something and feel cared for at the same time.
Blessings,
Chris A.
Posted by OldSchool on January 24, 2002, at 21:14:53
In reply to Re: The musical meds - incidence report » medlib, posted by Chris A. on January 23, 2002, at 1:37:07
> Tried to start a new thread, but my computer says "no."
>
> What's the procedure for filing an incidence report with a pharmaceutical company? Is it worth the effort to left them know of adverse events? I also had a lot of hopes for Geodon, but the akathisia dashed those.
> Do you know anything about filing incidence reports with the makers of ECT machines? Do they just get trashed?
>
> I don't have a legal bone in my body, but somehow feel someone needs to know that adverse events affect real people.
> Perhaps better meds and better treatments will emerge if we speak up. Dream on.
>
> Thanks,
>
> Chris A.
>
> P.S. Good to see you posting, Scott
>
> > I have to go fill out the incidence report Pfizer sent. (And it's been only 2 months since they received my complete report and inquiry! Guess it's a good thing I wasn't holding my breath waiting for assistance from *that* source.) Geodon didn't work for you either? I wonder how it's doing with schizophrenics; it hasn't exactly reached warp speed with Babblers, from what I've read so far.Reporting "adverse events" to the drug company that made the drug is a waste of time. You wont get anywhere doing that. The place to report adverse drug events is something called "FDA Medwatch." Medwatch is specifically set up as a centralized complaint department with the FDA. Upon request the FDA will send you Medwatch forms to fill out and return. The form you want is Medwatch Form 3500. You can have your doctor who prescribed the drug assist you in filling out the form if you wish. Or in many cases you might not be able to get your doctor to admit the drug caused you a problem and will refuse to help you fill it out. In which case you fill it out yourself and send it in.
The website for FDA Medwatch is:
I am getting ready to file a Medwatch complaint against Seroquel for causing me EPS back in the fall.
Old School
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