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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Jackd on March 18, 2002, at 18:47:50
Hey, it's already been a week since I've been on Remeron 30mg, Concerta 18mg, Klonopin 1mg and Lithium 600mg a day. I have still been cycling somewhat dramatically from feeling well to feeling like shit. Overall, the trend seems downward. I have noticed a pattern of rapid heart beating, physical nervousness, and overall sympathetic nervous system hyperactivity and hypoactivity. It's hard to pinpoint the exact correlation, but it seems that the hypoactivity is when I feel crappy, or about to, and the hyper is when, or before, I feel well. Again, this leads back to a possibly more complicated norepinephrine link to my ailment. All NE active medications have given me a very very rapid, robust response (as in after one pill) soon followed by a steadily worsening depression (worse than I started out). The lithium doesn't seem to be doing much but killing my highs and slightly smoothing things out.
Any thoughts or insights? I was thinking that maybe my brain has been so NE deficient that these meds cause an overstimulation of overly sensitive receptors, and thus cause a shortage of NE through a negative feedback loop. However, I thought Remeron was supposed to stop this by blocking the presynaptic Alpha 2 Autoreceptors. It has given me the best, longest lasting results, but the effect is still short lived.
Sigh...... I thought this lithium was my missing component. Now I'm thinking about toying with my NE system, possibly trying out NE agonists and whatnot. I NEED to find an answer soon; finals are coming up.
Posted by Carlos on March 18, 2002, at 22:01:08
In reply to Status on my med cocktail- John, Barbara, posted by Jackd on March 18, 2002, at 18:47:50
I might have missed it, but what are you taking all this for?
> Hey, it's already been a week since I've been on Remeron 30mg, Concerta 18mg, Klonopin 1mg and Lithium 600mg a day. I have still been cycling somewhat dramatically from feeling well to feeling like shit. Overall, the trend seems downward. I have noticed a pattern of rapid heart beating, physical nervousness, and overall sympathetic nervous system hyperactivity and hypoactivity. It's hard to pinpoint the exact correlation, but it seems that the hypoactivity is when I feel crappy, or about to, and the hyper is when, or before, I feel well. Again, this leads back to a possibly more complicated norepinephrine link to my ailment. All NE active medications have given me a very very rapid, robust response (as in after one pill) soon followed by a steadily worsening depression (worse than I started out). The lithium doesn't seem to be doing much but killing my highs and slightly smoothing things out.
>
> Any thoughts or insights? I was thinking that maybe my brain has been so NE deficient that these meds cause an overstimulation of overly sensitive receptors, and thus cause a shortage of NE through a negative feedback loop. However, I thought Remeron was supposed to stop this by blocking the presynaptic Alpha 2 Autoreceptors. It has given me the best, longest lasting results, but the effect is still short lived.
>
> Sigh...... I thought this lithium was my missing component. Now I'm thinking about toying with my NE system, possibly trying out NE agonists and whatnot. I NEED to find an answer soon; finals are coming up.
Posted by Jackd on March 18, 2002, at 23:18:27
In reply to Re: Status on my med cocktail- John, Barbara, posted by Carlos on March 18, 2002, at 22:01:08
I have ADD, depression and anxiety.
Posted by Jackd on March 19, 2002, at 0:05:02
In reply to Re: Status on my med cocktail- John, Barbara, posted by Jackd on March 18, 2002, at 23:18:27
I read something about rapid cycling being fixed by calcium channel blockers... and... something about certain adrenergic drugs "smoothing" out NE flow... Aren't some or all beta blockers calcium channel blockers? Could blocking them possibly leave even more NE for other receptors? I read a post by Cam LONG ago that downregulating NE beta receptors was a key in treating depression...
I could be WAY off... any ideas guys?
Posted by JohnX2 on March 19, 2002, at 3:05:25
In reply to Status on my med cocktail- John, Barbara, posted by Jackd on March 18, 2002, at 18:47:50
Hi Jack,I haven't tried Lithium so I am not too familiar with its start up effects ( I take lamictal ). I believe tremors can be a common start up effect on lithium and a beta blocker like Inderal may help with that. Are you finding that the lithium is just pulling in the highs and keeping the lows where they are with the additional side effects?
In what sense is the trend "downward". :(
Have you discussed this with your doc?regards
John> Hey, it's already been a week since I've been on Remeron 30mg, Concerta 18mg, Klonopin 1mg and Lithium 600mg a day. I have still been cycling somewhat dramatically from feeling well to feeling like shit. Overall, the trend seems downward. I have noticed a pattern of rapid heart beating, physical nervousness, and overall sympathetic nervous system hyperactivity and hypoactivity. It's hard to pinpoint the exact correlation, but it seems that the hypoactivity is when I feel crappy, or about to, and the hyper is when, or before, I feel well. Again, this leads back to a possibly more complicated norepinephrine link to my ailment. All NE active medications have given me a very very rapid, robust response (as in after one pill) soon followed by a steadily worsening depression (worse than I started out). The lithium doesn't seem to be doing much but killing my highs and slightly smoothing things out.
>
> Any thoughts or insights? I was thinking that maybe my brain has been so NE deficient that these meds cause an overstimulation of overly sensitive receptors, and thus cause a shortage of NE through a negative feedback loop. However, I thought Remeron was supposed to stop this by blocking the presynaptic Alpha 2 Autoreceptors. It has given me the best, longest lasting results, but the effect is still short lived.
>
> Sigh...... I thought this lithium was my missing component. Now I'm thinking about toying with my NE system, possibly trying out NE agonists and whatnot. I NEED to find an answer soon; finals are coming up.
Posted by Bill L on March 19, 2002, at 11:42:23
In reply to Re: Status on my med cocktail- Lithium help! » Jackd, posted by JohnX2 on March 19, 2002, at 3:05:25
Jack - A week is probably not long enough for the drugs to kick in.
Posted by Jackd on March 19, 2002, at 14:41:26
In reply to Re: Status on my med cocktail- Lithium help! » Jackd, posted by JohnX2 on March 19, 2002, at 3:05:25
The lithium is SOMEWHAT smoothing out the ups and downs, but I am still cycling rapidly (3-5 times a day) since I started the Remeron. The side effects I mentioned aren't a result of the LIthium, it's just something I've noticed more prominently this time around. I have always had a very overactive sympathetic nervous system; i easily blush, my heart goes nuts for stupid reasons. I'm in excellent shape too... Oh, and did I mention I have an irregular heart beat? So here's a more specific line of questioning for you... what meds help regulate NE release? what meds are good for rapid cycling? Are there any that may do both? As for the downward trend, well, what I mean is i am cycling between feeling good and bad, but the overall direction seems worse; as the days pass the good parts seem slightly less good and shorter lived, and the lows seem worse and longer.
Posted by Jackd on March 19, 2002, at 14:54:27
In reply to Re: Status on my med cocktail- Lithium help!, posted by Bill L on March 19, 2002, at 11:42:23
Bill, normally I'd agree with you, but Remeron and other NE acting meds kick in with me almost INSTANTLY. It does take a few weeks to get the full effect, but something funky is going on that I need to address.
Posted by JohnX2 on March 19, 2002, at 21:50:10
In reply to Re: Status on my med cocktail- Lithium help!, posted by Jackd on March 19, 2002, at 14:41:26
Hi Jack,Here are a few thoughts...(take them with a mound of salt as always).
Have you gone through a full check up?
The works on your thyroid, etc?I think some doctors seeing this degree of cycling dismissing any other issue may wish to approach the problem with more mood stabilizers and no/little AD if possible. I'm not sure I recall what your primary DX was. If I can remember it was depression with ADD not hyperactive. But those sort of ups and downs in 1 day with one medicine are quite profound. What does your doctor think of this? Maybe the remeron is not the way to go??? What was life like without the Remeron?
Just a thought, maybe bail on the ADs and try something like Lamictal which is an anticonvulsant with antidepressant properties.
Good for bad cycling patterns. Depakote may be helpful add on too (more for mood stabilization/less of an AD).Just wondering, do you feel you have problems with anxiety / problems socializing? Or is your "overactive sympathetic nervous system" more of just a physical nuisance you have learned to deal with.
There are medicines that people use for ADD as add ons for hyperactivity such as Clonidine and potentially Tenex (guanfacine). These would help to calm down a hyperactive sympathetic nervous system. These are alpha-2 agonist medicines. They may have depressant effects. They would be counterproductive to take with something like Remeron which is an alpha-2 antagonist.
To get a wild AD response on a medicine like Wellbutrin or Remeron in 1 day is really "unique". The medicine takes many days to exert its antidepressant effect, so whatever it is doing in 1 day is thought provoking to say the least.
best wishes
John
> The lithium is SOMEWHAT smoothing out the ups and downs, but I am still cycling rapidly (3-5 times a day) since I started the Remeron. The side effects I mentioned aren't a result of the LIthium, it's just something I've noticed more prominently this time around. I have always had a very overactive sympathetic nervous system; i easily blush, my heart goes nuts for stupid reasons. I'm in excellent shape too... Oh, and did I mention I have an irregular heart beat? So here's a more specific line of questioning for you... what meds help regulate NE release? what meds are good for rapid cycling? Are there any that may do both? As for the downward trend, well, what I mean is i am cycling between feeling good and bad, but the overall direction seems worse; as the days pass the good parts seem slightly less good and shorter lived, and the lows seem worse and longer.
This is the end of the thread.
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