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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by ross on March 14, 2002, at 9:14:20
saw her on tuesday. she put me on lithobid and took me off neurontin. i was a bit raveled when i asked what about an A/D. she said not yet. i see her in 2 weeks. she wants to first tackle my mood swings. she is a great listener and cares for her patients and does not have a full house. so we will see. i bought a bike 2 weeks ago i ride it 1/2 hour every morning and it really helps. other than that i still feel depressed.
ross
Posted by Penny on March 14, 2002, at 10:06:34
In reply to new pdoc very good, posted by ross on March 14, 2002, at 9:14:20
Ross,
Amazing what a good pdoc can do! I, too, think the world of my new pdoc. He's very available to me (I have his pager number), even though he actually practices in another city 2.5 hours away most of the week. Has really listened to me, doesn't have a time limit on his 'med check sessions.' He has been the one to hear what I had been saying for a while about my moods rapidly fluctuating. My last two pdocs just said "depression" and put me on ADs, but they haven't really worked. My new one has me trying one more round of ADs (80 mgs of Celexa & 450 mgs of Wellbutrin SR), and said that we should know by next week if this will work, and, if not (and that's the likelihood), we're going to start augmenting with mood stabilizers. He actually changed my diagnosis to "Mood Disorders NOS". He HEARS what I tell him. And is genuinely interested. Amazing.
Glad you're having a good experience. Wish everyone could be as lucky as it seems we are. I've been around the block with this, though, and it seems you probably have as well.
Keep us posted on how you're doing with the new meds.
Penny
> saw her on tuesday. she put me on lithobid and took me off neurontin. i was a bit raveled when i asked what about an A/D. she said not yet. i see her in 2 weeks. she wants to first tackle my mood swings. she is a great listener and cares for her patients and does not have a full house. so we will see. i bought a bike 2 weeks ago i ride it 1/2 hour every morning and it really helps. other than that i still feel depressed.
> ross
Posted by fachad on March 14, 2002, at 10:53:52
In reply to new pdoc very good, posted by ross on March 14, 2002, at 9:14:20
Great news.
Sounds like this pdoc has a plan and really wants the best for you.
Hope for the best!
Posted by IsoM on March 14, 2002, at 12:51:54
In reply to new pdoc very good, posted by ross on March 14, 2002, at 9:14:20
Ross, I was away from the computer for almost 2 wks. When I came back, I tried to catch up but obviously I missed something about you.
I thought you were taking Nardil & because you were just starting it, was waiting for it to kick in. What happened?
Posted by ross on March 14, 2002, at 21:10:36
In reply to Re: your Nardil » ross, posted by IsoM on March 14, 2002, at 12:51:54
first off the i gave Nardil a full 2 weeks and felt nothing. i know it takes longer than 2 weeks for somekind of effect but im not willing to give up everything for a med. its nice to not worry about the diet and my BP was way down on 60mgs. i would close my eyes and feel as if i was going to fall backwards. maybe it would have been what i was looking for and i went through hell to get on it but im seeing a new pdoc now and im open to new things. my social anxiety is not what i make it out to be. we all put to much into that!!
ross
Posted by JohnX2 on March 14, 2002, at 22:31:50
In reply to new pdoc very good, posted by ross on March 14, 2002, at 9:14:20
> saw her on tuesday. she put me on lithobid and took me off neurontin. i was a bit raveled when i asked what about an A/D. she said not yet. i see her in 2 weeks. she wants to first tackle my mood swings.
*GOOD* This is what my last pdoc did to me.
Shocked me to. Good luck!-John
Posted by IsoM on March 15, 2002, at 0:47:36
In reply to Re: your Nardil, posted by ross on March 14, 2002, at 21:10:36
If your blood pressure was that low, that's not good either. I remember reading a number of years ago (don't know if the idea is still accepted) that blood pressure that's too low doesn't get the needed oxygen to the brain cells so a person can feel mentally groggy as a result. You sure wouldn't need that along with depression. I'll be keeping an eye on your progress here. I hope it's good - in fact, I'm sure it's bound to be with your new doctor's attitude.
Posted by Geezer on March 15, 2002, at 14:48:21
In reply to new pdoc very good, posted by ross on March 14, 2002, at 9:14:20
> saw her on tuesday. she put me on lithobid and took me off neurontin. i was a bit raveled when i asked what about an A/D. she said not yet. i see her in 2 weeks. she wants to first tackle my mood swings. she is a great listener and cares for her patients and does not have a full house. so we will see. i bought a bike 2 weeks ago i ride it 1/2 hour every morning and it really helps. other than that i still feel depressed.
> rossHi Ross,
You are blessed! Wish I had a pdoc (30 years ago) that could recognize the importance of stabilizing the mood before DESTABILIZING it with the random addition of ADs. Only my opinion but I would stick with this one - might save you a lifetime of grief.
Best regardsGeezer
Posted by hal on March 16, 2002, at 18:31:41
In reply to new pdoc very good, posted by ross on March 14, 2002, at 9:14:20
> saw her on tuesday. she put me on lithobid and took me off neurontin. i was a bit raveled when i asked what about an A/D. she said not yet. i see her in 2 weeks. she wants to first tackle my mood swings. she is a great listener and cares for her patients and does not have a full house. so we will see. i bought a bike 2 weeks ago i ride it 1/2 hour every morning and it really helps. other than that i still feel depressed.
> rossHey Ross,
I have read through alot of your threads recently. Lithium is an okay med. It has a "flatening effect" on most individuals, whether your bipolar or not. Most individuals need to add some type of antidepressant to lithium and minimize the lithium dose in order to get an elevation in mood.
I really wish you were able to give nardil a good trial. The MAOIs are known to be the most potent antidepressants, giving the fullest/most dramatic response to patients. My situation was similar to yours, I finally responded to nardil at 60mg per day after 5 weeks. It was like a light switch one morning. I felt nothing before the 5th week and even asked my pdoc to try something else. Luckily, my pdoc made me stick it out til I responded. Now I am married, have a great job, jog 3 times a week and travel. Before nardil, I couldn't get out of bed!
So if the lithium doesn't work out, which I suspect it won't-not a good antidepressant, go back and give nardil a full trial.
Sincerely,
Hal
Posted by JohnX2 on March 17, 2002, at 1:26:05
In reply to Give Nardil a Good Try! » ross, posted by hal on March 16, 2002, at 18:31:41
>
> So if the lithium doesn't work out, which I suspect it won't-not a good antidepressant, go back and give nardil a full trial.
>
> Sincerely,
>
> HalI believe the strategy may be to stabilize any chaotic behaviour on the brain with a mood stabilizer before adding more fire (an antidepressant). This is a viewpoint shared by many psychiatrists who treat bipolar. My pdoc feels it will be nearly impossible to get a sustainable/predictable AD effect without using this approach.
John
Posted by michael on March 17, 2002, at 2:46:59
In reply to Give Nardil a Good Try! » ross, posted by hal on March 16, 2002, at 18:31:41
> I really wish you were able to give nardil a good trial. The MAOIs are known to be the most potent antidepressants, giving the fullest/most dramatic response to patients. My situation was similar to yours, I finally responded to nardil at 60mg per day after 5 weeks. It was like a light switch one morning. I felt nothing before the 5th week and even asked my pdoc to try something else. Luckily, my pdoc made me stick it out til I responded. Now I am married, have a great job, jog 3 times a week and travel. Before nardil, I couldn't get out of bed!
Can I ask what your experience has been with respect to side effects on nardil? Which, if any, did you get? Did they fade any with time?Tried any other maoi's?
Thanks for any info.
Posted by Hal on March 17, 2002, at 7:28:14
In reply to Re: Give Nardil a Good Try! » hal, posted by JohnX2 on March 17, 2002, at 1:26:05
> I believe the strategy may be to stabilize any chaotic behaviour on the brain with a mood stabilizer before adding more fire (an antidepressant). This is a viewpoint shared by many psychiatrists who treat bipolar. My pdoc feels it will be nearly impossible to get a sustainable/predictable AD effect without using this approach.
>
> JohnHey John,
I agree that those individuals with bonafide bipolar disorder require a mood stablizer as there base medication ..... that is crucial. But from reading Ross' threads, I was under the impression he was experiencing severe depression, not bipolar disorder. Maybe he could clarify his offical diagnosis for us?
Even if he has bipolar depression, MAOI are known to be the safest antidepressants ... they have the lowest rates of inducing mania/cycling. So even if he is bipolar, nardil or parnate would be a great med to start with.
Sincerely,
Hal
P.S. I really enjoy reading your post JohnX2.
Posted by Hal on March 17, 2002, at 7:31:55
In reply to Re: Give Nardil a Good Try! » hal, posted by michael on March 17, 2002, at 2:46:59
> > I really wish you were able to give nardil a good trial. The MAOIs are known to be the most potent antidepressants, giving the fullest/most dramatic response to patients. My situation was similar to yours, I finally responded to nardil at 60mg per day after 5 weeks. It was like a light switch one morning. I felt nothing before the 5th week and even asked my pdoc to try something else. Luckily, my pdoc made me stick it out til I responded. Now I am married, have a great job, jog 3 times a week and travel. Before nardil, I couldn't get out of bed!
>
>
> Can I ask what your experience has been with respect to side effects on nardil? Which, if any, did you get? Did they fade any with time?
>
> Tried any other maoi's?
>
> Thanks for any info.Hey,
I have had some weight gain, insomnia and delayed orgasm on nardil .... none have fade over time. These side effects were much more tolerable then persistant depression I had with SSRIs and effexor.
Hal
Posted by ross on March 17, 2002, at 8:49:48
In reply to Re: Give Nardil a Good Try!, posted by Hal on March 17, 2002, at 7:31:55
im bi-polar type 2. i just get the lows from the illness. i never had a manic day in my life. that was the diagnosis from my last pdoc for 6 years. in my mind im major depressed with OCD. i respond very well to meds and once we add an ssri i should be fine. i can see where she wanted to first get my mood swings under control with a tried and true mood stab. in lithium. neurontin was no longer holding my moods at 2400mgs a day. good med for anxiety although. some of me says i wish i gave nardil a bit longer but then some of me says let the new pdoc and shes a good one have the say in treating my depression.
ross
Posted by Hal on March 17, 2002, at 13:08:31
In reply to Re: Give Nardil a Good Try!, posted by ross on March 17, 2002, at 8:49:48
Hey Ross,
This whole Bipolar II fad upsets me. Several years ago when only lithuim was availible, psychiatrist where pretty reluctant to diagnose bipolar disorder unless they were confident about it. Now, with a whole slew of new meds for bipolar disorder, anyone who does not respond to an SSRI or effexor is labeled soft bipolar or bipolar II. Bipolar disease is a specific illness, with characteristic highs and lows ..... and not everyone with mood instablity not responding to meds should be labeled as bipolar spectrum.
I wish you the best of luck with your new doc and lithium. Remember, nardil and parnate will be availible if lithium is not sufficient.
Hal
Posted by Geezer on March 17, 2002, at 13:39:56
In reply to Re: Give Nardil a Good Try! » ross, posted by Hal on March 17, 2002, at 13:08:31
> Hey Ross,
>
> This whole Bipolar II fad upsets me. Several years ago when only lithuim was availible, psychiatrist where pretty reluctant to diagnose bipolar disorder unless they were confident about it. Now, with a whole slew of new meds for bipolar disorder, anyone who does not respond to an SSRI or effexor is labeled soft bipolar or bipolar II. Bipolar disease is a specific illness, with characteristic highs and lows ..... and not everyone with mood instablity not responding to meds should be labeled as bipolar spectrum.
>
> I wish you the best of luck with your new doc and lithium. Remember, nardil and parnate will be availible if lithium is not sufficient.
>
> HalHi Ross,
Looks like I am the opposing viewpoint on the Bipolar II issue. I was treated for Unipolar Recurrent Major Depression for 30 years - no mood stabilizers. Hospitalized 8 times, full disability in 1997, SSRIs are as useful as jelly beans, norep. drugs trigger dysphoric mixed states. Currently mixing various mood stabilizers with the hope of adding MAOI for the major depression. I never had anything resembling true MANIA. In my opinion any pdoc that treats a Bipolar patient (thank God for the differential DX) with an AD, without first stabilizing the patients mood, should be subject to charges for mal-practice.
Geezer
Posted by Hal on March 17, 2002, at 15:13:56
In reply to Re: Give Nardil a Good Try!, posted by Geezer on March 17, 2002, at 13:39:56
In my opinion any pdoc that treats a Bipolar patient (thank God for the differential DX) with an AD, without first stabilizing the patients mood, should be subject to charges for mal-practice.
>
> GeezerI agree 100%. But I disagree with doctors who label a depressed patient not responding to an antidepressant as bipolar II. I think Ross mentioned he has never had mania and only has experienced depression and anxiety. Now if a patient has had episodes of hypomania or dysphoric mania or rapid cyclicing, treat with a mood stalizer. Even still, most individual with bipolar ended up needing an antidepressant in the long run.
Sorry to hear you went through such an ordeal.
Hal
Posted by Geezer on March 17, 2002, at 16:18:56
In reply to Still would try Nardil/Parnate » Geezer, posted by Hal on March 17, 2002, at 15:13:56
> In my opinion any pdoc that treats a Bipolar patient (thank God for the differential DX) with an AD, without first stabilizing the patients mood, should be subject to charges for mal-practice.
> >
> > Geezer
>
> I agree 100%. But I disagree with doctors who label a depressed patient not responding to an antidepressant as bipolar II. I think Ross mentioned he has never had mania and only has experienced depression and anxiety. Now if a patient has had episodes of hypomania or dysphoric mania or rapid cyclicing, treat with a mood stalizer. Even still, most individual with bipolar ended up needing an antidepressant in the long run.
>
> Sorry to hear you went through such an ordeal.
>
> HalLooks like we are all in agreement. The only problem I had with Bipolar II DX was I didn't know I was Bipolar II until I was 57 years old. The reason......hypo-mania felt perfectly normal to me, and the old quack I was being treated by only saw me when I was severally depressed. I suppose the issue should be left up to Ross; if he agrees with his pdocs DX then he has the option to follow her recomendations or not. If he disagrees with the DX then he is free to follow another mode of treatment. In any case Ross I wish you well.
Geezer
Posted by Hal on March 17, 2002, at 18:23:48
In reply to Re: Still would try Nardil/Parnate, posted by Geezer on March 17, 2002, at 16:18:56
> > In my opinion any pdoc that treats a Bipolar patient (thank God for the differential DX) with an AD, without first stabilizing the patients mood, should be subject to charges for mal-practice.
> > >
> > > Geezer
> >
> > I agree 100%. But I disagree with doctors who label a depressed patient not responding to an antidepressant as bipolar II. I think Ross mentioned he has never had mania and only has experienced depression and anxiety. Now if a patient has had episodes of hypomania or dysphoric mania or rapid cyclicing, treat with a mood stalizer. Even still, most individual with bipolar ended up needing an antidepressant in the long run.
> >
> > Sorry to hear you went through such an ordeal.
> >
> > Hal
>
> Looks like we are all in agreement. The only problem I had with Bipolar II DX was I didn't know I was Bipolar II until I was 57 years old. The reason......hypo-mania felt perfectly normal to me, and the old quack I was being treated by only saw me when I was severally depressed. I suppose the issue should be left up to Ross; if he agrees with his pdocs DX then he has the option to follow her recomendations or not. If he disagrees with the DX then he is free to follow another mode of treatment. In any case Ross I wish you well.
>
> GeezerHey Geezer,
I had an experience opposite to yourself. I have had depression for many years, and tried to convince my pdoc I did not respond to SSRI/effexor because *I* thought I must be bipolar since my father is bipolar. I went through lithium, lamictal, neurontin. In the end, nardil worked.
But who knows, maybe I will have a manic episode in the future. I wish you and Ross the best.
Your Friend,
Hal
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