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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Aserone on August 14, 2004, at 7:24:11
I've been on many meds the last two years and nothing have worked really good for my Social phobia, depression and undiagnosed add. Me and my last psydoc didn't get along very good and my next appointment is in about a month with a new doc.
For now i've been selfmedicating, my father is a doctor but not a pd. So i do have little support but not much. My current drug regime is what i've put togetter through trial and error but i'm always afraid that this could go wrong.
Tramadol sr 200mg (mild snri+mild opioid agonist)
Selegiline 2.5mg (dopamine+phenylethylamine increase)
Alprazolam 1mg (benzo agonist+serotonin release)Sometimes more tramadol but never over 400mg/24 hours.
Those are daily. I also take.
Propranolol for stagefright.
Zopiclone/Triazolam/Hydroxyzine for sleep.
Codeine everything from nothing (mostly) to 300mg/day (rarly).I don't take anything to not function. I REALLY do just want to feel normal.
All i wanted from my last pd was an maoi or something for my severe social phobia but i've been so afraid to addmitting this mental disease because the nature of it. And when i brought it up he didn't belive me because i've been talking to him kinda frealy and about my depression. But i have a servere case where i do completely isolate myself from other people and don't have a chance of dating or anything. Getting on a bus or shopping is like hell. Even writing on a messageboard would have been really hard to do even when i'm sort of anonymous.
The secret to me beeing able to talk to him is becase i ALWAYS load up on opiates every time i must go to the doctor so when he tries to se how i look it isn't the real me. I did tell him this kinda.
Then he said "we've tried all there's nothing more, you don't need a med". I was stunned. So this is my life i'm 21 now and i'm going to have to live with my parents my whole life?? Yipee.. suicide dosen't sound to bad after all.
What do you guys and girls think? Could this go awry? I don't have a problem getting the meds because my dad, i don't need another doc for that. I'm very well informed about meds more so than most pdocs it seems, but this medecine soup IS bugging me without real medical support.
Anyone have any similar experience with this combo or any other good drugs for severe sp? Oops i almost forgot saying the combination works wonders for sp! But is it safe.. :/
Posted by Ame Sans Vie on August 15, 2004, at 7:42:35
In reply to What about this combo? NEVER seen it before..., posted by Aserone on August 14, 2004, at 7:24:11
> For now i've been selfmedicating, my father is a doctor but not a pd.
Always handy to have someone in the immediate family who wields the almighty prescription pad, lol. :-)
> So i do have little support but not much. My current drug regime is what i've put togetter through trial and error but i'm always afraid that this could go wrong.
>
> Tramadol sr 200mg (mild snri+mild opioid agonist)
> Selegiline 2.5mg (dopamine+phenylethylamine increase)
> Alprazolam 1mg (benzo agonist+serotonin release)
>
> Sometimes more tramadol but never over 400mg/24 hours.
>
> Those are daily. I also take.
>
> Propranolol for stagefright.
> Zopiclone/Triazolam/Hydroxyzine for sleep.
> Codeine everything from nothing (mostly) to 300mg/day (rarly).Well, I can tell you right now that the combination of drugs listed there should be perfectly safe for a relatively healthy 21 year old with a decent metabolism. I'm 21 myself and have been dealing with a primary diagnosis of social phobia accompanied by panic disorder, agoraphobia, OCD, avoidant personality disorder, dependent personality disorder, perhaps borderline personality disorder, endogenous reactive (atypical) depressive disorder, dysthymic disorder, and an extreme case of adult ADD. I was extremely hyperactive as a child, but as the social phobia really began to take over my life, my ADHD lost its hyperactivity component as I lost interest in life.
To scrutinize your drug combination a bit more carefully...
Tramadol -- its noradrenergic/serotonergic effects are certainly more prominent than its effects on the mu-opioid receptor following repeated dosage. After taking it for a while, it's as if it magically transforms into Effexor, lol. 200mg (and even 400mg occasionally) is a fine dose. I did well for a while using tramadol for depression, OCD and social phobia at 400mg day, but unfortunately developed an intolerance to the drug which caused my already painful muscles to hurt even more.
Selegiline -- wow, you actually find 2.5mg to be enough? Great! The possibility of an interaction at that dosage is practically nonexistant (though avoiding meperidine/pethidine, dextromethorphan and perhaps certain other opioids is important no matter which MAOI you're taking at whatever dose; morphine and Dilaudid are viewed by most doctors as safest to use with MAOIs, but if you're doing all right with tramadol and codeine then no worries!). The effect of selegiline at this dose, as I'm sure you're aware, involves far too little MAO type A inhibition to create cause of concern for serotonin syndrome.
Alprazolam -- it's great that you get along well on 1mg daily of alprazolam for social phobia... social phobes typically require somewhere in the 4 to 8mg per day range (slightly less than panic disorder patients treated with alprazolam). Only mild serotonergic action (though it does seem to hit the right spots! <g>), so an interaction is unlikely.
Propranolol -- many people consider these drugs harmless, but they are powerful antihypertensive/antianginals. Basically, beta-blockers are just "dirty" drugs in that they are unnecessarily attacking the entire body with equal force instead of focusing upon the nervous system. That's by no means meant to discourage you from *occasional* use of this drug, if you really think it helps. Though I wonder why you just don't take extra benzodiazepines for performance anxiety? Just a thought.
Zopiclone, triazolam and hydroxyzine: Perfectly safe, provided you don't take any of these hypnotics more often than twice (occasionally three times) weekly. Believe me -- you don't want to become immune to these drugs as I have and then have to go try to convince some doctor to prescribe a barbiturate (i.e., Seconal, Luminal, Mebaral, Nembutal). I keep a prescription of Tuinal (50% secobarbital + 50% amobarbital), Nembutal (pentobarbital) and Somnote (chloral hydrate -- "Mickey Finn", i.e., "slipping someone a mickey"). I havent needed them in quite a while since I found out that *amphetamine* before bed makes me sleep like a baby. If I need a really good, quick restorative nap though, I use sodium 4-hydroxybutyrate (Na-GHB). I synthesize the drug myself, and it is a Schedule I controlled substance when possessed without a prescription, but really I couldn't care less. I'll be (gratefully) abandoning this country sometime in the next year to live in Europe, and no one but me knows I make the stuff, so I dont worry about the pigs. All that I have to go through though is to be blamed on our severely mentally handicapped legislators here in the Not-So-United States of Hysteria who outlawed one of the most beneficial and safe 'drugs' known. The *only* thing that works for many insomniacs, depressives, narcoleptics, ADHDers and those with chronic fatigue syndrome or fibromyalgia. Instead of the good old days of $10 per bottle of pure Na-GHB at GNC, you now have to go through miles of red tape and then probably pay up to around $500 month for something that I can synthesize in my kitchen for about $20!
Codeine -- Still totally in the clear as far as I can see, though of course codeine and tramadol possess synergistic effects so exercise caution with the dosage (as I'm sure you already do), especially when taking tramadol and/or codeine along with the alprazolam, triazolam and zopiclone and to a lesser extent, the hydroxyzine.
> I don't take anything to not function. I REALLY do just want to feel normal.
Believe me, all of us here know exactly how that feels.
> All i wanted from my last pd was an maoi or something for my severe social phobia but i've been so afraid to addmitting this mental disease because the nature of it. And when i brought it up he didn't belive me because i've been talking to him kinda frealy and about my depression.
That's so ignorant on your doctors behalf that I *could* go off on a five-page rant solely on the topic of doctors not listening to their patients because they "know best" and yet several doctors with whom I've discussed MAOIs have literally responded with, "what's an MAOI?"??!! Christ, the guy went to med school and is officially recognized as a doctor of psychopharmacology, but everytime I would bring up a new drug I'd been researching (everything from gabapentin a few years ago to pramipexole and tramadol last year), he would go to reach for his PDR and by the time he had found the drug's listing I already had explained it's mechanism of action, dosing, side effects and safety info. The same would go for when *he* would suggest a new drug therapy -- now, most drugs he suggested I just truthfully answered that I'd tried them and they didn't work for me and made me worse. When he recommended one I *hadn't* tried, it would go something like this:
~Have you tried Lamictal?
~No, but I know it's an anticonvulsant thats supposedly antidepressant. I would really rather not try another medication with that type of effect on serotonin after my experiences with Paxil, Zoloft, Luvox, Celexa, Serzone and Remeron.
~I dont know where you hear this about lamotrigine affecting serotonin levels in any direct way, that's ridiculous. You read too much about these drugs (?!?!?!) -- just let me do my job and we'll have you feeling well in no time.
~Funny, I would think that a healthy interest, curiosity and skepticism concerning the drugs you're trying to force on me, as well as research into the subject to help me understand my treatment, would be a *good* thing. I will not try the Lamictal -- I know what works for me and what doesnt. I've tried serotonergics in all shapes, forms and colors. And I would guess, judging from past experience with these types of glutamatergic, GABAergic and glycinergic drugs, that Lamictal will simply make me miserable. Besides, I break out in rash and/or hives from taking acetaminophen, aspirin, ibuprofen, naproxen, ketoprofen, etc -- I'm not going to risk Stevens-Johnson just to prove to you what *I* already know.
~(the above pissed him off a bit, heh) The nurse will give a sample box and instruction on dosing on your way out.
~Can't we talk about other options, like that medication you mentioned to me several months back? Adderall?
~Adderall? You'd have an anxiety attack with your first dose. I would never have suggested such a thing........You get the idea. He certainly did suggest Adderall two months prior I snuck a look at the notes on my chart when he stepped out to see if he had Lamictal samples. He caught me and ignored me to call in his next patient when I confronted him. The only reason I went back for the one-week followup was to show him that what I had predicted prior to starting Lamictal was spot on. I developed all the usual adverse effects of SSRIs, including outward physical manifestations as joint swelling and dry, cracking skin (i.e., things that were indisputably there, as opposed to complaints of psychiatric adverse effects) that were documented in my medical history (right in front of him on the desk) as being a reaction I had to Zoloft, Paxil, Luvox, Serzone, and Celexa. I also got the potentially deadly Lamictal rash which I told him I was worried about. He looked at my charts, per my request, but being the far superior human being that he is, he failed to apologize for not being more thorough. So two weeks later I started at a new pdoc who immediately started me on Klonopin 4mg/day and Adderall XR 30mg/day. All I had to do was tell him I'd been taking Klonopin at 2mg daily to which he replied, "2mg? What, was your last psychiatrist the Marquis de Sade?" lmao... pretty close. He increased me to 5mg daily after we spoke about it and I had told him my panic attacks were neither letting up in frequence nor severity at the 2mg/day. My social phobia was a little better, but maybe by about 10% In other words, I could manage to open the front door to sign for a package from UPS instead of acting like I wasnt home so as to not have to expose all my imagined (and some real... not too many, lol j/k <g>) flaws to another human being... not to mention the consequences of opening the front door and having to stand there and breathe outdoor air. I was housebound for two years like this.
> What do you guys and girls think? Could this go awry? I don't have a problem getting the meds because my dad, i don't need another doc for that. I'm very well informed about meds more so than most pdocs it seems, but this medecine soup IS bugging me without real medical support.
The best thing you could do for yourself, in my opinion, is to begin some form of talk therapy... perhaps starting off one-on-one then progressing to group therapy. If your dad can write out the prescriptions, I don't see much of a point of going and spending years like most of us do looking for a good... no... *acceptable* doctor. Let's just say that it sure seems with a lot of these doctors that *they're* the one who isn't playing with a full deck, so to speak, lol. Then again, they *do* devote their lives to hearing crazy people complain all day long... perhaps enough to drive them mad? lol
> Anyone have any similar experience with this combo or any other good drugs for severe sp? Oops i almost forgot saying the combination works wonders for sp! But is it safe.. :/I've used similar combinations. I had a great result with pramipexole, clonazepam, alprazolam, and tramadol for several months when I started experiencing sleep-attacks due to the pramipexole. Selegiline was all right, but I likely wasnt taking a sufficient dose -- everything has to be 2-10x the normal dose for me. I need a minimum of 8mg in a single dose of alprazolam to realize any benefit; not due to tolerance -- my mom gave me 10 x 1mg Xanax when I was 15 years old because I had been having horrible nightmares lately. One pill didn't do a thing, neither did two, nor four. So I took the last six. An hour after taking them I began to feel less tense than usual, but nothing mindblowing and it certainly didn't help me sleep. I once used propranolol at 20mg three times daily because I was having constant somatic symptoms of anxiety and my idiot doctor wouldnt increase my Klonopin above 2mg. Propranolol put me into the most lethargic, anhedonic, fatigued, apathetic depression (<~~ oxymoron? lol) that I've ever been through.
I've tried so many dozens of other drugs and remedies over the years, but I don't have the time at the moment to type another five hundred pages <g>. Right now what works for me is:
Klonopin 4mg each eight hours -- 12mg daily
Adderall ~20mg each six hours -- ~80mg daily
Dexalone 30mg each six hours -- 120mg daily
Desipramine 200mg before bed -- 200mg dailyI just started the desipramine a few days ago, but so far it's doing an *unbelievable* job of potentiating the *good* effects of the Adderall, thus I decreased my dose from 30mg q6h to ~20mg q6h yesterday. Keeping fingers crossed!
Just keep in mind that I'm not a health professional and all the above is opinion, educated guesswork, and some facts. (Yes, I believe that was me attempting to cover my legal ass there, lol)
All the best,
~Michael
Posted by Iansf on August 15, 2004, at 15:11:09
In reply to Re: What about this combo? -- Warning -- Long post » Aserone, posted by Ame Sans Vie on August 15, 2004, at 7:42:35
> Tramadol -- its noradrenergic/serotonergic effects are certainly more prominent than its effects on the mu-opioid receptor following repeated dosage. After taking it for a while, it's as if it magically transforms into Effexor, lol. 200mg (and even 400mg occasionally) is a fine dose. I did well for a while using tramadol for depression, OCD and social phobia at 400mg day, but unfortunately developed an intolerance to the drug which caused my already painful muscles to hurt even more.
>How long was "a while" in your case? I took it for about three weeks and experienced no benefits. Maybe I didn't give it long enough.
This is the end of the thread.
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