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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Mishal on November 29, 2007, at 4:10:57
Hi
I won't listen to any discouraging warning anymore. I stopped taking Trivastal a week ago, and these seven days have been the worst. Don't get it wrong, It was not Trivastal withdrawal at all, but my original symptoms all returned tormenting me. Anhedonia, apathy all what makes one feeling like crap returned.
Now, I restarted Trivastal again at night with some Motilium (domperidon). I was afraid whether Trivastal would upset my stomach to make me extremely nauseated. But that (domperidon) was not necessary. Domperidon (an anti-emetic) only served to dull me in the morning. But that dullness has gone and I am starting to feel much much much better now.
I am not going to give up this med again. Simply because I don't want to feel like crap anymore. If there is a wonderful med that can drive all apathy and anhedonia away right after a single dose at night, why the hell I should stay off it?
I won't cross the bridge until I reach it. If there is a downside for feeling good, I don't care. I am bound to this living moment. I am living it at this time. So let me be on Trivastal.
Cheers.
Posted by bulldog2 on November 29, 2007, at 7:57:10
In reply to On Trivastal Again. Feeling soooooooo goood.., posted by Mishal on November 29, 2007, at 4:10:57
> Hi
>
> I won't listen to any discouraging warning anymore. I stopped taking Trivastal a week ago, and these seven days have been the worst. Don't get it wrong, It was not Trivastal withdrawal at all, but my original symptoms all returned tormenting me. Anhedonia, apathy all what makes one feeling like crap returned.
>
> Now, I restarted Trivastal again at night with some Motilium (domperidon). I was afraid whether Trivastal would upset my stomach to make me extremely nauseated. But that (domperidon) was not necessary. Domperidon (an anti-emetic) only served to dull me in the morning. But that dullness has gone and I am starting to feel much much much better now.
>
> I am not going to give up this med again. Simply because I don't want to feel like crap anymore. If there is a wonderful med that can drive all apathy and anhedonia away right after a single dose at night, why the hell I should stay off it?
>
> I won't cross the bridge until I reach it. If there is a downside for feeling good, I don't care. I am bound to this living moment. I am living it at this time. So let me be on Trivastal.
>
> Cheers.
>
>Good for you! It's not like your taking a street drug. This was prescribed by your d-doc. If you can't get more than four hours sleep a night you might ask your doc for something to help you sleep.
Posted by Phillipa on November 29, 2007, at 12:09:39
In reply to Re: On Trivastal Again. Feeling soooooooo goood.., posted by bulldog2 on November 29, 2007, at 7:57:10
What's bad about trivestal? isn't it a parkinson's med off label? Phillipa
Posted by bulldog2 on November 29, 2007, at 13:44:39
In reply to On Trivastal Again. Feeling soooooooo goood.., posted by Mishal on November 29, 2007, at 4:10:57
> Hi
>
> I won't listen to any discouraging warning anymore. I stopped taking Trivastal a week ago, and these seven days have been the worst. Don't get it wrong, It was not Trivastal withdrawal at all, but my original symptoms all returned tormenting me. Anhedonia, apathy all what makes one feeling like crap returned.
>
> Now, I restarted Trivastal again at night with some Motilium (domperidon). I was afraid whether Trivastal would upset my stomach to make me extremely nauseated. But that (domperidon) was not necessary. Domperidon (an anti-emetic) only served to dull me in the morning. But that dullness has gone and I am starting to feel much much much better now.
>
> I am not going to give up this med again. Simply because I don't want to feel like crap anymore. If there is a wonderful med that can drive all apathy and anhedonia away right after a single dose at night, why the hell I should stay off it?
>
> I won't cross the bridge until I reach it. If there is a downside for feeling good, I don't care. I am bound to this living moment. I am living it at this time. So let me be on Trivastal.
>
> Cheers.
>
>Mishal
How come you take it at night instead of the morning?
Posted by Sigismund on November 29, 2007, at 14:03:02
In reply to Re: On Trivastal Again. Feeling soooooooo goood.., posted by bulldog2 on November 29, 2007, at 13:44:39
Maybe taking the short acting version in the morning would lessen the insomnia?
Posted by clipper40 on November 29, 2007, at 17:19:41
In reply to On Trivastal Again. Feeling soooooooo goood.., posted by Mishal on November 29, 2007, at 4:10:57
What is the usual dosage of Trivastal for depression?
Definitely no need to go off of a medication that is obviously helping you so much! I hope it continues to help you this much forever!!
Posted by cumulative on November 29, 2007, at 17:29:53
In reply to Re: On Trivastal Again. Feeling soooooooo goood.. » Mishal, posted by clipper40 on November 29, 2007, at 17:19:41
Trivastal is not prescribed for depression -- Mishal is using it off-label, as I shortly will be doing as well. A D1/D2/D3 agonist with additional alpha-2 adrenergic activity and stable blood levels over 24 hours, I believe it has tremendous potential in conditions that are linked to poor dopaminergic function -- such as ADD, and anergic depression. It's a French drug used (only) in Parkinson's disease and has been noted to have particular use in improving inattention, apathy, anhedonia -- these three probably the cornerstones of my psychiatric troubles.
Mishal takes 50mg/daily IIRC; I have the opportunity of using up to 250mg/daily (a dose used in Parkinson's monotherapy) if I so choose, but I imagine I'll be taking a lower dose.
What I plan is: I will also try to acquire an alpha-2 agonist such as clonidine (preferably guanfacine, but I need to find a source) to offset Trivastal's adrenergic effects in the evening and allow me to get full sleep, and perhaps a dose in the morning as well. Though I respond very well to dopaminergics, I do not tolerate strong adrenergic effects very well, hence my problems with psychostimulants. I'm not sure how strong this stimulation from Trivastal is, so we'll see.
In addition, I may be adding additional items, such as Lyrica (pregabalin) for sleep quality (which I think Mishal tried as well).
Updates forthcoming!
Posted by cumulative on November 29, 2007, at 19:09:53
In reply to Re: On Trivastal Again. Feeling soooooooo goood.., posted by cumulative on November 29, 2007, at 17:29:53
My worry is that Trivastal has too much activity at D2, and not enough at D1. Functionally, the effect may be to increase hyperactive, hedonic behavior without giving much help with what I really need -- attention, focus, verbal fluency. Prefrontal dopamine, which might be more D1. So I dunno, especially if I do end up wanting to block some of the adrenergic effects.
Then again, Mishal described "laser-sharp focus" and high interest in what he was doing, so hopefully I'll pick up some of that.
Posted by clipper40 on November 29, 2007, at 23:55:49
In reply to Re: On Trivastal Again. Feeling soooooooo goood.., posted by cumulative on November 29, 2007, at 17:29:53
> Trivastal is not prescribed for depression -- Mishal is using it off-label, as I shortly will be doing as well. A D1/D2/D3 agonist with additional alpha-2 adrenergic activity and stable blood levels over 24 hours, I believe it has tremendous potential in conditions that are linked to poor dopaminergic function -- such as ADD, and anergic depression. It's a French drug used (only) in Parkinson's disease and has been noted to have particular use in improving inattention, apathy, anhedonia -- these three probably the cornerstones of my psychiatric troubles.
>
> Mishal takes 50mg/daily IIRC; I have the opportunity of using up to 250mg/daily (a dose used in Parkinson's monotherapy) if I so choose, but I imagine I'll be taking a lower dose.
>
> What I plan is: I will also try to acquire an alpha-2 agonist such as clonidine (preferably guanfacine, but I need to find a source) to offset Trivastal's adrenergic effects in the evening and allow me to get full sleep, and perhaps a dose in the morning as well. Though I respond very well to dopaminergics, I do not tolerate strong adrenergic effects very well, hence my problems with psychostimulants. I'm not sure how strong this stimulation from Trivastal is, so we'll see.
>
> In addition, I may be adding additional items, such as Lyrica (pregabalin) for sleep quality (which I think Mishal tried as well).
>
> Updates forthcoming!
We have many of the same issues: inattention, apathy, anhedonia and I don't tolerate noradrenergics easily. Don't know yet how I will respond to dopaminergics but I'm guessing it will be well. I'm very interested in hearing how you do on this medication and especially how severe the noradrenergic effects are.Good luck and thanks for your response!
Posted by bulldog2 on November 30, 2007, at 4:58:33
In reply to A possible hitch., posted by cumulative on November 29, 2007, at 19:09:53
> My worry is that Trivastal has too much activity at D2, and not enough at D1. Functionally, the effect may be to increase hyperactive, hedonic behavior without giving much help with what I really need -- attention, focus, verbal fluency. Prefrontal dopamine, which might be more D1. So I dunno, especially if I do end up wanting to block some of the adrenergic effects.
>
> Then again, Mishal described "laser-sharp focus" and high interest in what he was doing, so hopefully I'll pick up some of that.When you consider people with pd can take up to 5 pills the adregenic affects shouldn't be severe at 1 pill as a start. That is what is unique about this med.Otherwise you would be better off with a more standard dopamine agonist. NE can also play an important role in depression. I talked with someone who used it and he didn't find it to stimulating certainly not like a classical stimulant.Anyhow I will probably try it as an adjunct to low dose luvox.From what I read on the servier site their also prescribing this for cognitive difficulties.
Posted by Phillipa on November 30, 2007, at 19:57:53
In reply to Re: A possible hitch., posted by bulldog2 on November 30, 2007, at 4:58:33
Bulldog what will you be taking luvox wise and how much of this med. And benzos? Phillipa ps where were you last night? No one at my toes.
Posted by anonymoose on December 1, 2007, at 11:52:18
In reply to Re: On Trivastal Again. Feeling soooooooo goood.., posted by clipper40 on November 29, 2007, at 23:55:49
Us dopaminergic depressives have been so ill-served by current clinical psychiatry and its hard-on for SSRIs. I think it's scandalous how unwilling to acknowledge they are (or ignorant of the fact that) there is a significant subset of us out there that neither need or want increased serotonergic transmission.
I haven't been posting much lately, because I've been too busy getting out and living life, starting to rebuild over the rubble of 10 years of SSRI-worsened anhedonia...and having a ball of a time doing it.
Been on .75mg/day of Mirapex, and the difference has been remarkable. Nothing like my experience with SSRIs and SNRIs, which turned out to be no better than placebo (I hope it works...I think it's working...Maybe it's working...D***, this ain't doing jack s***.) By the fourth day, the effect was like a lightbulb turning on. The anergia slowly melted away, and I could finally get off the couch and do simple things around the house if I wanted to, like vacuum the nasty carpet. The terrible dementia-like symptoms, which I had been fearing would be permanent, also melted away, with my severely damaged cognition and verbal fluency steadily returning to normal levels.
I'm currently at about a ~70% level of symptomatic remission, with my healthy pre-depression mental state of age 17 serving as the baseline. .75mg/day is a relatively low dosage, and I probably could have asked the doc to increase it already, but I've been holding off to see if I can kickstart my own natural dopamine synthesis into action with basic supplementation (B Complex, DLPA, Omega-3s).
Side effects have been minor, and included some initial nausea and decreased appetite. My biggest complaint was the whacked-out sleep caused I think by the increased D2-stimulation at night, but I fixed that by taking the Mirapex earlier in the day.
I'm guessing that dopamine agonists don't directly increase dopaminergic vesicular stores, because the agonist isn't subject to the reuptake pump like natural dopamine is? If that's the case, would it be preferable in the long run to shoot for increased natural dopamine synthesis (via supplementation or MAO-B inhibition, etc.) instead of relying on "synthetic dopamine" like the agonists?
If you were to increase dopamine in the synaptic cleft via MAO-B inhibition, for example, would the DAT (dopamine transporter) eventually upregulate in response? If my logic serves me correctly, this upregulation would be a good thing over the long run, right? Since it will help to replenish vesicular stores?
Posted by bulldog2 on December 1, 2007, at 18:16:55
In reply to Re: A possible hitch. » bulldog2, posted by Phillipa on November 30, 2007, at 19:57:53
> Bulldog what will you be taking luvox wise and how much of this med. And benzos? Phillipa ps where were you last night? No one at my toes.
Currently at 50 mg of luvox for the last four days. Hoping to get up to 100 mg and see what that does. I will do 50 milligrams of trivastal when it comes. Hopefully this combo which will hit SE, NE and Da will give me something like a maoi which hits all the neurontransmitters without having to go high on the luvox or trivastal. Hopefully I will be able to give your feet some kisses tonight.
Posted by bulldog2 on December 1, 2007, at 18:23:03
In reply to Re: A possible hitch. » bulldog2, posted by Phillipa on November 30, 2007, at 19:57:53
> Bulldog what will you be taking luvox wise and how much of this med. And benzos? Phillipa ps where were you last night? No one at my toes.
Oh and 1 to 2 milligrams of klonopin a day as needed. Hopefully this combo will give me a version of Nardil which hits a bit of everything.
If this combo doesn't work might try nardil early next year after the knee procedure.
Posted by Phillipa on December 1, 2007, at 18:24:47
In reply to Re: A possible hitch., posted by bulldog2 on December 1, 2007, at 18:16:55
Ohhhh that calls for a pedicure and special sweet smelling cream. Need to look up the trivestal. So with l00mg of luvox this will be like let's say nardil or emsam? If so might try it too. Phillipa
Posted by bulldog2 on December 1, 2007, at 18:33:37
In reply to Re: A possible hitch. » bulldog2, posted by Phillipa on December 1, 2007, at 18:24:47
> Ohhhh that calls for a pedicure and special sweet smelling cream. Need to look up the trivestal. So with l00mg of luvox this will be like let's say nardil or emsam? If so might try it too. Phillipa
Hopefully low dose luvox, trivastal and klonopin will take care of the depression, anxiety (including social anxiety)and anhedonia. Would nice if a combo of meds could give me what an maoi does without all the restrictions. If not considering nardil. To many years being wasted not feeling well so an maoi is not out of the question.
Posted by Phillipa on December 1, 2007, at 18:42:36
In reply to Re: A possible hitch., posted by bulldog2 on December 1, 2007, at 18:33:37
Well if it arrives today we will try it together as you sleep at my feet. Greg won't care he'll be asleep. Phillipa
Posted by florence on December 6, 2007, at 0:38:11
In reply to Re: A possible hitch. » bulldog2, posted by Phillipa on December 1, 2007, at 18:42:36
Posted by kingcolon on December 7, 2007, at 17:49:27
In reply to Re: A possible hitch., posted by bulldog2 on December 1, 2007, at 18:33:37
> > Ohhhh that calls for a pedicure and special sweet smelling cream. Need to look up the trivestal. So with l00mg of luvox this will be like let's say nardil or emsam? If so might try it too. Phillipa
>
> Hopefully low dose luvox, trivastal and klonopin will take care of the depression, anxiety (including social anxiety)and anhedonia. Would nice if a combo of meds could give me what an maoi does without all the restrictions. If not considering nardil. To many years being wasted not feeling well so an maoi is not out of the question.Why not try Provigil instead? It provides the adrenergic stimulation, and recent research shows it increases dopamine indirectly via inhibition of GABA inputs on dopaminergic neurons. I'm using adrafanil at the moment (virtually identical to Provigil) simply because I had an old stock of it and do not have insurance coverage for Provigil which is much more expensive. It is available from Europe off-shore pharmacies. I've had very good responses to both in terms of anhedonia, fatigue, amotivation, focus, and antidepressant effects. I use it in conjunction with Cymbalta.
Posted by florence on December 12, 2007, at 4:18:46
In reply to On Trivastal Again. Feeling soooooooo goood.., posted by Mishal on November 29, 2007, at 4:10:57
Very glad for you! Wish i felt the same..Can't feel any happiness...wish i could get some for xmas...so tired of this day after day..year after year..another year when i can't wait til the holiday season is over..cuz of how crappy i feel. I pray it will continue to work well for you. florence
************Hi
>
> I won't listen to any discouraging warning anymore. I stopped taking Trivastal a week ago, and these seven days have been the worst. Don't get it wrong, It was not Trivastal withdrawal at all, but my original symptoms all returned tormenting me. Anhedonia, apathy all what makes one feeling like crap returned.
>
> Now, I restarted Trivastal again at night with some Motilium (domperidon). I was afraid whether Trivastal would upset my stomach to make me extremely nauseated. But that (domperidon) was not necessary. Domperidon (an anti-emetic) only served to dull me in the morning. But that dullness has gone and I am starting to feel much much much better now.
>
> I am not going to give up this med again. Simply because I don't want to feel like crap anymore. If there is a wonderful med that can drive all apathy and anhedonia away right after a single dose at night, why the hell I should stay off it?
>
> I won't cross the bridge until I reach it. If there is a downside for feeling good, I don't care. I am bound to this living moment. I am living it at this time. So let me be on Trivastal.
>
> Cheers.
>
>
This is the end of the thread.
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