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Dr. Bob is Robert Hsiung, MD,
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Posted by 4WD on June 12, 2005, at 22:19:58
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
> 1. Effexor is like Tramadol, correct???
>
> 2. Tramadol makes me feel that old Nardil euphoria
>
> 3. Therefore, I'm going to go and try Nardil and Effexor together!
>
> Don't worry, i have Periactin and adalat on hand if any probs crop up!!!
>
> Please comment, experiences, call me an idiot, a lovely man, etc etc!!
>
> Ace!Effexor is like tramadol? Huh?
When I took Effexor, I was calm and smooth and not anxious. When I took tramadol, I was tense, jittery and nervous, like too much coffee.
Marsha
Posted by Dr. Bob on June 14, 2005, at 22:18:48
In reply to Exercise for severe depression, posted by linkadge on June 12, 2005, at 15:35:34
> There are quite a number of studies that show that exercise is very effective even in severe depression.
Sorry to interrupt, but I'd like to redirect follow-ups regarding exercise to Psycho-Babble Health. Here's a link:
http://www.dr-bob.org/babble/health/20050411/msgs/512835.html
Thanks,
Bob
Posted by SLS on June 15, 2005, at 7:04:50
In reply to Redirect: Exercise for severe depression, posted by Dr. Bob on June 14, 2005, at 22:18:48
> > "No magic pill in sight?"
> I beg to differ. The effect I experience from the meds I am on now is truly magical.> I feel blessed by God to have access to them, and now know that I must get my act together and contribute something magnificent and useful to humanity because I have been given this profound gift...
You already have.
- Scott
Posted by Questionmark on June 15, 2005, at 18:41:48
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
i believe Effexor is a much more potent SRI (serotonin reuptake inhibitor) than Tramadol is. i could see how a little extra 5-HT reuptake inhibition would make you feel "that old Nardil euphoria," but i question whether it would be worthwhile. Even if it is, you should definitely be extremely cautious and start w/ a very very low dose of SSRI. But as ChairmanMAO said, i think you might be better off using 5-HTP or tryptophan (and/or maybe even something like inositol as well)-- while still being cautious w/ those.
After experimenting w/ minimally low doses of Paxil w/ my Nardil (very rarely & occasionally) to determine how much i might be able to safely take that would also be effective in the way i desired,... i got to the point of using a low dose of Paxil every now and then (again, very very rarely) to powerfully augment my Nardil and get a strong serotonergic effect for a day. i did this for various reasons, but primarily just when i wanted to be in a highly prosocial and happy state for whatever particular reason. (((i STRONGLY RECOMMEND AGAINST THIS PRACTICE FOR ANYONE HOWEVER, FOR A # OF REASONS))).
i would use about 2.5mg - 7mg-- maybe a bit higher (up to 10mg?), but i can't remember for sure-- when on either 45 or 60mg Nardil per day (those are the Nardil doses i have always been on). i have only done this several times or so.
So, firstly, you might be able to go above the absolute maximum doses of Effexor that Chairman MAO mentions (since Paxil is more potent than Effexor, by weight)-- depending on your current dose of Nardil and % MAO inhibition-- but, i really strongly caution against this... (unless maybe you know some brilliant psychopharmacologist who insists that it is fine and explains why).
...
The reasons for this: (1)Who knows what this does to your brain and neurochemistry, especially doing it daily {{[E.g., what if it eventually results in profound apathy and/or inhibition of DA transmission; what if it eventually results in profound 5-HT receptor adaption and tolerance; what if it results in 5-HT neurotoxicity and neuron death (similar to MDMA?)?]}}, (2)Your libido will be eradicated, (3)It may be damaging to your muscles and kidneys, if not more (read about physical effects of serotonin syndrome-- of which your med combo may be a constant at-least-mild form), (4)coma or death due to serotonin syndrome, (5)etc. (?).
Therefore, i advise against it.
Good luck though.> 1. Effexor is like Tramadol, correct???
>
> 2. Tramadol makes me feel that old Nardil euphoria
>
> 3. Therefore, I'm going to go and try Nardil and Effexor together!
>
> Don't worry, i have Periactin and adalat on hand if any probs crop up!!!
>
> Please comment, experiences, call me an idiot, a lovely man, etc etc!!
>
> Ace!
Posted by ed_uk on June 15, 2005, at 18:59:40
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
Hi Andrew!
>Please comment, experiences, call me an idiot, a lovely man, etc etc!!
Didn't you once combine Nardil with Anafranil and suffer terrible side effects? Well.........
Effexor + Nardil would be worse!!!
Kind regards,
Ed.
Posted by ed_uk on June 15, 2005, at 19:02:05
In reply to Re: Nardil + Effexor...I'm going for it!!!! » ace, posted by Questionmark on June 15, 2005, at 18:41:48
Hi!!!
>i got to the point of using a low dose of Paxil every now and then (again, very very rarely) to powerfully augment my Nardil and get a strong serotonergic effect for a day.
That's interesting. What were the psychological effects of this combination?? What side effects did you have?
Kind regards,
Ed.
Posted by ConfuzyQ on June 16, 2005, at 7:09:37
In reply to Re: tramadol, posted by Jakeman on June 12, 2005, at 14:12:09
> I've found that tramadol used occasionally will lift my depression within hours and make me feel more outgoing. Is it prescribed for depression for long-term use? Thanks
> ~Jake
>It works that way for me too, and also helps with my organization and prioritizing. The research that has been done has found it helps with OCD too, which is one of the things I may have some variant of. I have used it as a pinch-hit for most of the past two years, limiting myself to the lowest dose that seems capable of helping me (25 to 75 mg/day).
The secondary topic of my tramadol use recurs throughout a thread I have going here right now, started as "Depression getting on Strattera?" (FYI, during the thread I changed my posting name from Spoc.) You probably wouldn't learn much new from reading it, but hey, if you're bored... ;-)
I'm guessing that even if Effexor is a much more potent SRI than tramadol, if the smaller gun is working it would be the better choice...
I soooo wish tramadol would be looked into more (but I haven't been paying attention to whether it has). As much as it keeps me pasted together in low dose, I would love to see how much it could help at a higher dose. But I won't go that far on my own, and have accepted that it will probably never be anything more than something I use on my own as a pinch hit when I am not seeing any docs or trying/taking anything else. I would love to hear that I'm wrong on that.
Posted by Jakeman on June 16, 2005, at 10:36:42
In reply to Re: tramadol: wish it would be researched more!! » Jakeman, posted by ConfuzyQ on June 16, 2005, at 7:09:37
> > I've found that tramadol used occasionally will lift my depression within hours and make me feel more outgoing. Is it prescribed for depression for long-term use? Thanks
> > ~Jake
> >
>
> It works that way for me too, and also helps with my organization and prioritizing. The research that has been done has found it helps with OCD too, which is one of the things I may have some variant of. I have used it as a pinch-hit for most of the past two years, limiting myself to the lowest dose that seems capable of helping me (25 to 75 mg/day).
>
> The secondary topic of my tramadol use recurs throughout a thread I have going here right now, started as "Depression getting on Strattera?" (FYI, during the thread I changed my posting name from Spoc.) You probably wouldn't learn much new from reading it, but hey, if you're bored... ;-)
>
> I'm guessing that even if Effexor is a much more potent SRI than tramadol, if the smaller gun is working it would be the better choice...
>
> I soooo wish tramadol would be looked into more (but I haven't been paying attention to whether it has). As much as it keeps me pasted together in low dose, I would love to see how much it could help at a higher dose. But I won't go that far on my own, and have accepted that it will probably never be anything more than something I use on my own as a pinch hit when I am not seeing any docs or trying/taking anything else. I would love to hear that I'm wrong on that.
>I didn't know about the other thread- thanks. I agree, I would also like to see more information about Tramadol being used as ongoing treatment for depression. I've read anecdoctal reports that its used off-label in Europe for atypical depression. Maybe Ed-UK knows something about that? I initially got Tramadol for back pain and found it didn't help much there. But in that short trial it did give me more energy, and mood and focus improved. I've only taken it intermittently since then. I've read long-time users have some nasty withdrawal effects. But that's true with many widely used meds for depression and anxiety.
~J
Posted by Chairman_MAO on June 17, 2005, at 12:43:13
In reply to Re: tramadol: wish it would be researched more!! » Jakeman, posted by ConfuzyQ on June 16, 2005, at 7:09:37
mu-opioid agonists are proven to help with OCD. It is likely that this is why tramadol helps. It's monoamine reuptake inhibition is simply too weak to be clinically significant in that regard, IMHO.
Posted by ConfuzyQ on June 17, 2005, at 13:34:31
In reply to Re: tramadol: wish it would be researched more!! » ConfuzyQ, posted by Chairman_MAO on June 17, 2005, at 12:43:13
Thank you chairman! I'll be up front about my ignorance...
> mu-opioid agonists are proven to help with OCD.
As a point of reference, what other drugs are examples of that class?
> It's monoamine reuptake inhibition is simply too weak to be clinically significant in that regard, IMHO.
And that means it probably isn't clinically significant in helping with ______?
Thanks again; and if possible, it would be great if you could comment on these tramadol questions I posted today:
http://www.dr-bob.org/babble/20050617/msgs/514240.html
Posted by Questionmark on June 17, 2005, at 17:52:31
In reply to Paxil/Nardil » Questionmark, posted by ed_uk on June 15, 2005, at 19:02:05
> Hi!!!
>
> >i got to the point of using a low dose of Paxil every now and then (again, very very rarely) to powerfully augment my Nardil and get a strong serotonergic effect for a day.
>
> That's interesting. What were the psychological effects of this combination?? What side effects did you have?
>
> Kind regards,
> Ed.
Hey.
Some psychological and other effects of this combination were a strong sense of happiness (wouldn't exactly say euphoria-- not sure why, just didn't "feel" like "euphoria" usually does);
high prosociability w/ lots of talking, smiling, and moderate laughing-- almost pressured speech at times-- with a strong desire to talk to people... so strong in fact that i actually i had to restrain myself to some extent;
physical restlessness;
muscle tension (e.g., tight clenching of certain muscles especially my fists, arms, and jaw);
excessive sweating and feelings of warmth;
having lots of physical energy and maybe strength;
and, occasional periods of obnoxiousness and giddiness (not in the sense of automatic laughter-- as cannabis often gives or as does experiencing something truly hilarious-- but not exactly forced laughter either).
i also had feelings of mostly physical anxiety, but the psychological lessening of inhibitions overpowered these feelings.
i remember thinking how 'i wish i could always feel like this,' but i'm not really sure if it would be the best state for certain situations (e.g., giving a speech (?), a close & serious one-on-one conversation, etc.). i do think there are certain situations where this sort of state would probably be detrimental though. And i strongly question whether or not this sort of practice is good for oneself.
Posted by Questionmark on June 17, 2005, at 18:04:57
In reply to Re: tramadol: wish it would be researched more!! » ConfuzyQ, posted by Chairman_MAO on June 17, 2005, at 12:43:13
> mu-opioid agonists are proven to help with OCD. It is likely that this is why tramadol helps. It's monoamine reuptake inhibition is simply too weak to be clinically significant in that regard, IMHO.
Hi. Do you think that mu-opioid agonists would or might also be helpful for OCPD??
Also, do you know if there are any effective ways to use mu agonists to help OCD (or OCPD) in a long-term and continual or semi-continual manner (i.e., mostly, in a way that will not result in tolerance to this effect)?
Thanks.
Posted by ed_uk on June 17, 2005, at 18:21:42
In reply to Re: Paxil/Nardil » ed_uk, posted by Questionmark on June 17, 2005, at 17:52:31
Hi QM,
Thanks for the detailed reply :-)
>Some psychological and other effects of this combination were a strong sense of happiness.......
:-)
>physical restlessness; muscle tension (e.g., tight clenching of certain muscles especially my fists, arms, and jaw);excessive sweating and feelings of warmth.......
All common 'serotonergic' effects. Celexa makes me sweat a lot and clench my jaw.
>And i strongly question whether or not this sort of practice is good for oneself.
Keep the Paxil dose very low!
Kind regards,
Ed.
Posted by willyee on June 20, 2005, at 19:44:37
In reply to Re: Paxil + Nardil » Questionmark, posted by ed_uk on June 17, 2005, at 18:21:42
> Hi QM,
>
> Thanks for the detailed reply :-)
>
> >Some psychological and other effects of this combination were a strong sense of happiness.......
>
> :-)Exessive sweating was always a marker for me that i was heading for an interaction.There is also unresltleness,u lay down but pop back up.There is ehnanced sociability,and energy,but it is maniac like.Last when u do chrash,theres a terrable depression that follows.This of course is only my opinion.
>
> >physical restlessness; muscle tension (e.g., tight clenching of certain muscles especially my fists, arms, and jaw);excessive sweating and feelings of warmth.......
>
> All common 'serotonergic' effects. Celexa makes me sweat a lot and clench my jaw.
>
> >And i strongly question whether or not this sort of practice is good for oneself.
>
> Keep the Paxil dose very low!
>
> Kind regards,
> Ed.
>
Posted by ed_uk on June 20, 2005, at 20:18:41
In reply to Re: Paxil + Nardil, posted by willyee on June 20, 2005, at 19:44:37
Hi William,
>Exessive sweating was always a marker for me that i was heading for an interaction.
Which drugs did you take with Parnate which caused this reaction?
~Ed
Posted by 4WD on June 20, 2005, at 22:58:36
In reply to Re: Exercise for severe depression » linkadge, posted by SLS on June 13, 2005, at 21:55:09
>
> I thank you for your concern regarding my unrealistic expectations. However, they are based in the reality I have seen all around me for the last 23 years. Sick people get very well with biological intervention. For each of these individuals, whatever got them that way is to them magic. I was fortunate enough once to have been awakened by such magic for 6 months. I intend to awaken again - this time for 6 decades. Actually, I might now be in the midst of that process without the benefit of exercise.
>
Scott,I guess you mean from the addition of Trileptal? I hope it works for you. I know how hard you've struggled and I hope you've finally found something that will give you the magic.
What difference is the Trileptal making? How do you feel differently?
Please keep us posted.
Marsha
Posted by SLS on June 20, 2005, at 22:58:37
In reply to Re: Exercise for severe depression, posted by 4WD on June 15, 2005, at 23:43:47
> >
> > I thank you for your concern regarding my unrealistic expectations. However, they are based in the reality I have seen all around me for the last 23 years. Sick people get very well with biological intervention. For each of these individuals, whatever got them that way is to them magic. I was fortunate enough once to have been awakened by such magic for 6 months. I intend to awaken again - this time for 6 decades. Actually, I might now be in the midst of that process without the benefit of exercise.
> >
>
>
> Scott,
>
> I guess you mean from the addition of Trileptal? I hope it works for you. I know how hard you've struggled and I hope you've finally found something that will give you the magic.
>
> What difference is the Trileptal making? How do you feel differently?
>
> Please keep us posted.
>
> Marsha
Hi Marsha.Yeah. I was referring to the Trileptal. I'm now getting the impression that I'm going to need to raise the dosage from the 600mg I'm now taking. At least I pray it is as simple as that. I seem to have plateaud. Getting beyond the first two weeks of a response is critical for me. If after two weeks there continues to be a trend toward improvement, I believe I'll be on the road to recovery. Right now, I am disappointed.
- Scott
Posted by 4WD on June 20, 2005, at 22:58:39
In reply to Re: Exercise for severe depression » 4WD, posted by SLS on June 17, 2005, at 3:14:15
> > What difference is the Trileptal making? How do you feel differently?
> >
> > Please keep us posted.
> >
> > Marsha
>
>
> Hi Marsha.
>
> Yeah. I was referring to the Trileptal. I'm now getting the impression that I'm going to need to raise the dosage from the 600mg I'm now taking. At least I pray it is as simple as that. I seem to have plateaud. Getting beyond the first two weeks of a response is critical for me. If after two weeks there continues to be a trend toward improvement, I believe I'll be on the road to recovery. Right now, I am disappointed.
>
>
> - Scott
Okay, Scott. The Trileptal has to work. I don't want to embarrass or offend you but you are one of the people on this board that I pray for regularly. (I'm not particularly religious; my concept of God has more to do with trees and nature and quantum physics than it does with hymns and vestments). Anyway I had been praying for you for about a week when you posted that the Trileptal was helping. So I course I got all excited, thinking, "wow, I was *heard*!" (My belief is not all that rock steady and absolute at this point) So now, you just have to continue to improve. (And I'll continue to pray).Marsha
Posted by SLS on June 20, 2005, at 22:58:39
In reply to Re: Exercise for severe depression » SLS, posted by 4WD on June 17, 2005, at 21:43:29
Hi. Marsha.
I have the BIGGEST smile on my face right now.
You are something special.
I guess your prayers are still helping as Trileptal is still working.
I am still anxious, though, because I haven't made it past the two-week mark yet. Also, I can't say that the trend is towards further improvement. I don't think I feel better this week than I did last week. I am worried that my response has plateaud. However, I believe that for me, any true antidepressant response will take weeks or months to develop into something more robust. I am impatient. I think I will be much more patient once I become convinced that the trend is towards further improvement two to four weeks from now.
> (I'm not particularly religious; my concept of God has more to do with trees and nature and quantum physics than it does with hymns and vestments).
Great minds think alike. Great hearts feel alike.
I guess...
Thanks for everything.
- Scott
Posted by 4WD on June 20, 2005, at 22:58:41
In reply to Re: Exercise for severe depression » 4WD, posted by SLS on June 18, 2005, at 8:39:09
> Hi. Marsha.
>
> I have the BIGGEST smile on my face right now.
>
> You are something special.
>
> I guess your prayers are still helping as Trileptal is still working.
>
> I am still anxious, though, because I haven't made it past the two-week mark yet. Also, I can't say that the trend is towards further improvement. I don't think I feel better this week than I did last week. I am worried that my response has plateaud. However, I believe that for me, any true antidepressant response will take weeks or months to develop into something more robust. I am impatient. I think I will be much more patient once I become convinced that the trend is towards further improvement two to four weeks from now.
>
> > (I'm not particularly religious; my concept of God has more to do with trees and nature and quantum physics than it does with hymns and vestments).
>
> Great minds think alike. Great hearts feel alike.
>
> I guess...
>
> Thanks for everything.
>
>
> - ScottWow. A big smile. I'm glad you had a day with a smile in it.
I've read in your previous posts that you often notice improvement during or after dosage changes up or down. And you've got quite a range of upward dosing possibility for the Trileptal left, right? I mean you can still go up quite a bit. So if the plateau stays the same now, won't the improvement likely start back up when you increase dosage? As long as you can maintain the plateau of improvement you've got now?
I was reading something last night about the difference in melancholic depression and atypical depression and I thought about you. You feel better in the morning and worse at night. I feel worse in the morning and better at night. The former is the pattern for atypical depression. My pattern fits the description for melancholic depression. It seems to me they ought at least to categorize ADs as to which ones work better for the two types of depression.
And thank *you* for everything.
Marsha
Posted by SLS on June 20, 2005, at 22:58:42
In reply to Re: Exercise for severe depression » SLS, posted by 4WD on June 18, 2005, at 15:58:00
> > Hi. Marsha.
> >
> > I have the BIGGEST smile on my face right now.
> >
> > You are something special.
> >
> > I guess your prayers are still helping as Trileptal is still working.
> >
> > I am still anxious, though, because I haven't made it past the two-week mark yet. Also, I can't say that the trend is towards further improvement. I don't think I feel better this week than I did last week. I am worried that my response has plateaud. However, I believe that for me, any true antidepressant response will take weeks or months to develop into something more robust. I am impatient. I think I will be much more patient once I become convinced that the trend is towards further improvement two to four weeks from now.
> >
> > > (I'm not particularly religious; my concept of God has more to do with trees and nature and quantum physics than it does with hymns and vestments).
> >
> > Great minds think alike. Great hearts feel alike.
> >
> > I guess...
> >
> > Thanks for everything.
> >
> >
> > - Scott
>
> Wow. A big smile. I'm glad you had a day with a smile in it.
>
> I've read in your previous posts that you often notice improvement during or after dosage changes up or down. And you've got quite a range of upward dosing possibility for the Trileptal left, right? I mean you can still go up quite a bit. So if the plateau stays the same now, won't the improvement likely start back up when you increase dosage? As long as you can maintain the plateau of improvement you've got now?
>
> I was reading something last night about the difference in melancholic depression and atypical depression and I thought about you. You feel better in the morning and worse at night. I feel worse in the morning and better at night. The former is the pattern for atypical depression. My pattern fits the description for melancholic depression. It seems to me they ought at least to categorize ADs as to which ones work better for the two types of depression.
>
> And thank *you* for everything.
>
> Marsha
>
They sorta do categorize. You would be likely to respond to a tricyclic if you are:1. Melancholic.
2. Morning is the worst time of day.
3. Early morning awakenings.
4. Psychomotor retardation.
5. Poor appetite
6. Elevated cortisol / DST non-suppressor
7. Feelings of guilt
- Scott
Posted by 4WD on June 20, 2005, at 22:58:44
In reply to Re: Exercise for severe depression » 4WD, posted by SLS on June 18, 2005, at 21:52:37
>>
>
> They sorta do categorize. You would be likely to respond to a tricyclic if you are:
>
> 1. Melancholic.
> 2. Morning is the worst time of day.
> 3. Early morning awakenings.
> 4. Psychomotor retardation.
> 5. Poor appetite
> 6. Elevated cortisol / DST non-suppressor
> 7. Feelings of guilt
>
>
> - ScottOh! Oh! Oh! That's me! How come nobody ever told me that before!?? I'm printing out that list and taking it to my new pdoc. The only things that aren't exactly me are the poor appetite (but that's kind of moot because I'm a recovering bulimic and food was always solace to me and hunger had nothing to do with it and *now* I can't eat at all in the daytime) and the early awakenings. That's just started in the last year and happens on Lexapro, Cymbalta and Celexa. On Prozac (ten years ago) it was the opposite, insomnia falling asleep but sleeping very late. But then the Prozac was causing the insomnia.
And I had already posted to you about having had a good response to imipramine years ago.
Oh, I feel like maybe you've told me where the holy grail is and now I just have to go get it.
Thank you Scott!
Posted by ed_uk on June 20, 2005, at 22:58:45
In reply to Re: Exercise for severe depression, posted by 4WD on June 18, 2005, at 22:56:22
Are you gonna try imipramine again??
~Ed
Posted by 4WD on June 20, 2005, at 22:58:51
In reply to Re: Exercise for severe depression » 4WD, posted by ed_uk on June 19, 2005, at 11:37:04
> Are you gonna try imipramine again??
>
> ~Ed
I think what I'm going to do is keep on with Celexa but lower it to 10mg one day and 5mg the next for a week. Then maybe 5 mg per day for a week. At that point I'll be to June 30 which is my first appt with my new pdoc. That way I'll have a head start on a taper. Then I'll tell him what I've taken, what results I've had, what I've been feeling like on the Celexa and how I feel after having lowered it. I'll tell him what supplements I'm taking. And I'll sit back and see what he suggests. But I'll have my list of possibilities in my pocket. If anything he suggests jives with what I've been thinking, I'll know we're on the right wave length. My possibilities are: 1.stay on Celexa, add Lamictal. 2.Stop Celexa, switch to tricyclic, probably imipramine. 3. Switch to Lexapro (don't really like this one). 4. Stop ADs, go with supplements. 5. Try Nardil. (not in any particular order of preference.)
But I'm going to wait and just see what he says without any prompting from me. That way if we both arrive at some particular conclusion independently, I'll feel really good about it.Marsha
Posted by 4WD on June 20, 2005, at 22:58:52
In reply to Re: Exercise for severe depression » 4WD, posted by ed_uk on June 19, 2005, at 11:37:04
> Are you gonna try imipramine again??
>
> ~EdThe only reason I'm not jumping wholeheartedly on the imipramine idea exclusively is that I remember some issues with insomnia, postural hypotension, muscle tension pain and spasms in my neck and shoulders, nasal congestion and dry mouth as side effects. I'd be willing to deal with that if I have to --and if remission comes along with it. Unless, of course he's a miracle worker and can get me into remission without any side effects :-)
Marsha
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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