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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Phil on October 25, 2005, at 16:42:38
Going to the well with you one more time Scott. Hope you see this post.
I'm still taking Lamictal 400mg, Symbyax 6/50mg, and 1.5mg Klonopin.
I can tell that my depression is getting worse but have a pdoc that says, 'Gee Phil, you've been on all these meds(40+ over the years) before. Go exercise or something because the meds aren't going to do it all.' I don't disagree with what he says but I don't think he realizes the level of depression I'm dealing with. I don't see myself bootstrapping my way out of this.
Since being DX'ed with BPII, I've pretty much been on this combo. I've seen this doc for about 8 months and the previous doc had this regimen in place for a while.
I'm having a bit of a problem with this. Any ideas? Is there a way to tweak this combo that comes to mind? Should I just go run around the block?Thanks,
Phil
Posted by Phil on October 25, 2005, at 16:44:33
In reply to SOS for SLS, posted by Phil on October 25, 2005, at 16:42:38
How are you doing these days?
Posted by Chairman_MAO on October 25, 2005, at 18:30:41
In reply to SOS for SLS, posted by Phil on October 25, 2005, at 16:42:38
Buprenorphine + MAOI of your choice + dopamine agonist (I like cabergoline; no sedation) (if side effects are not the issue, I liked phenelzine the best) is by far the best "TRD-ish" combo I've ever tried. If one added memantine to it, I'll bet that would substantially potentiate it.
Posted by SLS on October 25, 2005, at 18:33:14
In reply to SOS for SLS, posted by Phil on October 25, 2005, at 16:42:38
Hi Phil.
It is unfortunate that this doctor has taken the posture that there is something that you are not doing for yourself that is otherwise within your control to do. There isn't.
As a fellow bipolar depressive, I have developed a respect for the utility of anticonvulsants to be used as mood stabilizers. I recently experienced brief antidepressant responses to Trileptal and Keppra. If you haven't tried these drugs, I would give them a shot. They can simply be added to what you are already taking. There is no reason to discontinue anything.
I guess it might make sense to consider adding in another antidepressant. Wellbutrin would probably be the first to try. Remeron might also be of some utility.
Personally, I would scrap the Symbiax and divide up the two components to be worked with independantly. You can then maintain Zyprexa at 10mg while you attempt to use drugs other than Prozac along with it. Zoloft? Effexor? Cymbalta?
Parnate + lithium + Lamictal + Zyprexa
Parnate + nortriptyline + Lamictal + ZyprexaI am currently taking:
Parnate 80mg
nortriptyline 100mg
Lamictal 150mg
Abilify 10mg
Keppra 1000mgAll of these drugs only add up to about a 15% improvement in my condition, but it is significantly better than nothing. Perhaps they would do more for you. I find Abilify to be "cleaner" than Zyprexa and helps with mental energy and motivation. Still, I got a hell of a nice antidepressant kick when I first added Zyprexa to Nardil and later to Parnate. Only lasted about a week, though. Crap.
What do you think?
There are a lot of sharp people here with other ideas. Let's see what else is out there. Stick around the Medication board for a little while and really press the issue.
- Scott
> Going to the well with you one more time Scott. Hope you see this post.
> I'm still taking Lamictal 400mg, Symbyax 6/50mg, and 1.5mg Klonopin.
> I can tell that my depression is getting worse but have a pdoc that says, 'Gee Phil, you've been on all these meds(40+ over the years) before. Go exercise or something because the meds aren't going to do it all.' I don't disagree with what he says but I don't think he realizes the level of depression I'm dealing with. I don't see myself bootstrapping my way out of this.
> Since being DX'ed with BPII, I've pretty much been on this combo. I've seen this doc for about 8 months and the previous doc had this regimen in place for a while.
> I'm having a bit of a problem with this. Any ideas? Is there a way to tweak this combo that comes to mind? Should I just go run around the block?
>
> Thanks,
> Phil
Posted by SLS on October 25, 2005, at 18:38:57
In reply to Re: SOS for SLS » Phil, posted by Chairman_MAO on October 25, 2005, at 18:30:41
> Buprenorphine + MAOI of your choice + dopamine agonist (I like cabergoline; no sedation) (if side effects are not the issue, I liked phenelzine the best) is by far the best "TRD-ish" combo I've ever tried. If one added memantine to it, I'll bet that would substantially potentiate it.
Are you still taking cabergoline?I think memantine is worth trying, however, people report that it seems to be of limited use because its most robust antidepressant effects wane very quickly - usually within two to three weeks. I was disappointed in it. My guess is that it makes for a better opioid augmentor than an antidepressant/stimulant potentiator.
- Scott
Posted by emme on October 25, 2005, at 18:51:56
In reply to Re: SOS for SLS » Chairman_MAO, posted by SLS on October 25, 2005, at 18:38:57
Hi there.
I second Scott on trying the memantine. My pdoc has had tremendous success with some of her patients on it. It's had a reasonably well sustained antidepressant effect for me (I've been taking it since last winter). I'm very med sensitive and get overmedicated at the drop of a hat. So I have to keep the dose low and that limits the benefit I get from it. But from what I understand of it, the side effect profile is fairly low for most people.
emme
Posted by spriggy on October 25, 2005, at 19:55:25
In reply to Re: memantine, posted by emme on October 25, 2005, at 18:51:56
I just thought I would share something my doctor told me back in march (while starting Lamictal).
He said, " if you feel depressed on it, let me know, I've seen people get worse while on this stuff."
Posted by Racer on October 25, 2005, at 22:44:54
In reply to hey Phil, posted by spriggy on October 25, 2005, at 19:55:25
>
> He said, " if you feel depressed on it, let me know, I've seen people get worse while on this stuff."
>
>I was one of those people. Once I hit 100mg, I had a day or two of feeling better, which faded fast. Same again at both 150 and 200. Overall, though, I was depressed, somewhat suicidal -- more in the 'it's just not worth living' than anything more active -- anxious, sedated, amotivated, and constipated. I don't know which of those was the worst, but the last was way up there on the list.
Of course, if it's been working for you, well, then don't fix what ain't broke.
I don't have any direct experience with anti-psychotics, but what Scott said makes a great deal of sense to me: split it up into its component parts, if the Prozac portion isn't working adequately, it's easy enough to try something that might help more. Plus, of course, you can fine tune your dosages.
I hope things get better soon, Phil -- and that your doctor grows a clue. Or you find a new one who does. (Do you have any choice in who you see?)
Posted by phil on October 26, 2005, at 5:58:58
In reply to Hey Phil -- I'm one of those people » spriggy, posted by Racer on October 25, 2005, at 22:44:54
Thanks everyone. I feel I have some options now. I do need to hang around the med board again and will be spending time here.
Racer, I do have options on who I see though they're limited. I've never had a shrink that was so reluctant to try new options. Most throw pills at me faster than I can swallow them. If this guy won't consider med options, I'll drop him and search out another.Phil
Posted by phil on October 26, 2005, at 6:57:59
In reply to Re: Hey Phil -- I'm one of those people » Racer, posted by phil on October 26, 2005, at 5:58:58
Has anyone else had good results treating the depression side of bipolar?
Posted by Racer on October 26, 2005, at 11:00:13
In reply to Re: Hey Phil -- I'm one of those people » Racer, posted by phil on October 26, 2005, at 5:58:58
> > Racer, I do have options on who I see though they're limited. I've never had a shrink that was so reluctant to try new options. Most throw pills at me faster than I can swallow them. If this guy won't consider med options, I'll drop him and search out another.
>
> PhilI highly recommend that last course of action. Trust me on this one, Buddy -- it's very, very therapeutic to fire a doctor! While I doubt it's appropriate for your situation, it's even more therapeutic to fire a psychiatrist and then report him to the state medical board.
I really hope that you do get relief soon, Phil. Take good care of yourself, and don't internalize this guy's idiotic bootstrapping condescension. (And for goodness sake, don't internalize my appalling spelling!)
Posted by phil on October 26, 2005, at 18:03:29
In reply to A non-med option to augment the meds » phil, posted by Racer on October 26, 2005, at 11:00:13
Racer, Please see my thread on Social. I think I'll call it something like I'm firing two doctors. See if I'm justified.
Thanks...
Posted by willyee on October 27, 2005, at 10:09:45
In reply to Re: SOS for SLS » Chairman_MAO, posted by SLS on October 25, 2005, at 18:38:57
> > Buprenorphine + MAOI of your choice + dopamine agonist (I like cabergoline; no sedation) (if side effects are not the issue, I liked phenelzine the best) is by far the best "TRD-ish" combo I've ever tried. If one added memantine to it, I'll bet that would substantially potentiate it.
>
>
> Are you still taking cabergoline?
>
> I think memantine is worth trying, however, people report that it seems to be of limited use because its most robust antidepressant effects wane very quickly - usually within two to three weeks. I was disappointed in it. My guess is that it makes for a better opioid augmentor than an antidepressant/stimulant potentiator.
>
>
> - Scott
>
>
>I could be mistaken,but ive never seen anyone here in the U.S speak of or prescribed memintine.
So two questions,is this a med that can be scripted here in the U.S and also isnt this the med i see that cost in the upper two doller area for ike 30 pills or so?
Posted by SLS on October 27, 2005, at 10:20:18
In reply to Re: SOS for SLS, posted by willyee on October 27, 2005, at 10:09:45
There are a few people on PB that have tried memantine to augment antidepressants or stimulants. I found it transiently helpful, but ultimately, I was disappointed.
Memantine has been available in the U.S. for over a year as the trade name Namenda. It is indicated for use in treating moderate - severe Alzheimers Dementia.
- Scott
This is the end of the thread.
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