![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 15 to 39 of 40. Go back in thread:
Posted by tensor on February 15, 2023, at 3:59:45
In reply to Re: Meds for severe anxiety » tensor, posted by undopaminergic on February 15, 2023, at 3:36:55
Just had a call with my doc, I managed to get my point through, that my anxiety is not under control and that we need to look at other options. As a side note, I'm chronically depressed and am on disability pension. Though finding relief for anxiety is more important now, it doesn't hurt if the treatment can lift my energy a bit.
As I had anticipated, her immediate reaction to pregabaline was no, like a knee jerk reaction. But I emphasized my anxiety is severe and that I would only take it as needed. She paused for a while (probably reading my journal) and asked if I was interested in trying Ketamine. But said she needed to consult with previous doc about what to do since he knows me better.
What do think about Ketamine?/tensor
Posted by tensor on February 15, 2023, at 4:03:05
In reply to Re: Meds for severe anxiety » tensor, posted by undopaminergic on February 15, 2023, at 3:36:55
> Maybe tell the doctor that benzos are (often) harder to quit than opioids or even SSRIs.
>
> -undopaminergic
>My doc won't get schooled by me :) Also, opioids build tolerance over time so that's a hard pass.
/tensor
Posted by tensor on February 15, 2023, at 4:06:09
In reply to Re: Meds for severe anxiety » tensor, posted by undopaminergic on February 15, 2023, at 3:04:16
> There are a lot of sedating APs, but sulpiride is not one of them. In fact, it can be a stronger stimulant than methylphenidate (Ritalin), especially at the start of treatment.
>
> -undopaminergic
>Low dose sulpiride is a med I have been using on and off in the past, it does have a calming effect at a low dose for me, like 50 mg.
/tensor
Posted by undopaminergic on February 15, 2023, at 11:52:43
In reply to Re: Meds for severe anxiety » undopaminergic, posted by tensor on February 15, 2023, at 4:06:09
> > There are a lot of sedating APs, but sulpiride is not one of them. In fact, it can be a stronger stimulant than methylphenidate (Ritalin), especially at the start of treatment.
> >
> > -undopaminergic
> >
>
> Low dose sulpiride is a med I have been using on and off in the past, it does have a calming effect at a low dose for me, like 50 mg.
>
> /tensorIt is very selective for dopamine D2 and D3 receptors, but apparently does something with GHB receptors as well. I assume you haven't tried Xyrem?
-undopaminergic
Posted by tensor on February 15, 2023, at 12:02:43
In reply to Re: Meds for severe anxiety » tensor, posted by undopaminergic on February 15, 2023, at 11:52:43
> It is very selective for dopamine D2 and D3 receptors, but apparently does something with GHB receptors as well. I assume you haven't tried Xyrem?
>
> -undopaminergic
>I haven't tried any illicit drugs or something that wasn't prescribed to me. I'm too scared of s/e, one of my 150 phobias.
You have any experience with Ketamine?
/tensor
Posted by undopaminergic on February 15, 2023, at 12:16:14
In reply to Re: Meds for severe anxiety » undopaminergic, posted by tensor on February 15, 2023, at 12:02:43
> > It is very selective for dopamine D2 and D3 receptors, but apparently does something with GHB receptors as well. I assume you haven't tried Xyrem?
> >
> > -undopaminergic
> >
>
> I haven't tried any illicit drugs or something that wasn't prescribed to me. I'm too scared of s/e, one of my 150 phobias.
>Xyrem is a prescription drug that contains the sodium salt of GHB:
https://en.wikipedia.org/wiki/Sodium_oxybate> You have any experience with Ketamine?
>No. Memantine and methoxetamine are as close as I got to it so far. Memantine gave euphoria and methoxetamine gave dysphoria...
-undopaminergic
Posted by Jay2112 on February 15, 2023, at 16:11:14
In reply to Re: Meds for severe anxiety » Jay2112, posted by tensor on February 15, 2023, at 3:47:19
Just throwing out a few other meds (I am going to re-try these actually).
1. Nabilone (generic name) It's the synthetic equivalent of THC. It has a gentle anti-anxiety effect.
2. Propranolol (beta-blocker used extensively in anxiety/depression treatment) and/or a calcium channel blocker.
3. Risperdal (generic name risperidone) Atypical antipsychotic. Greatly reduces agitated depression/anxiety.
4. Methoprazine (brand name Nozinan here in Canada) Hit/or/miss, but works when nothing else does.
5. Have to mention choline again. It's been found to be very low in people with GAD/Panic Attacks.
I'd really take a shot at ketamine. It's not perfect, but is a very unique treatment.
Jay
Posted by atypical on February 15, 2023, at 23:19:15
In reply to Meds for severe anxiety, posted by tensor on February 14, 2023, at 6:03:51
Have you tried a MAOI?
Posted by tensor on February 16, 2023, at 2:55:30
In reply to Re: Meds for severe anxiety, posted by atypical on February 15, 2023, at 23:19:15
> Have you tried a MAOI?
Yes I have tried Parnate but not Nardil. Quite good for panic, but is loses efficacy after a while and I eventually hit max dose. Also the afternoon crash was a big drawback.
Posted by tensor on February 16, 2023, at 3:21:50
In reply to Re: Meds for severe anxiety » tensor, posted by Jay2112 on February 15, 2023, at 16:11:14
Hi Jay!
> 1. Nabilone (generic name) It's the synthetic equivalent of THC. It has a gentle anti-anxiety effect.I have to research this one.
> 2. Propranolol (beta-blocker used extensively in anxiety/depression treatment) and/or a calcium channel blocker.
I use propranolol periodically and it's a med worth having in my arsenal especially for situational anxiety.
> 3. Risperdal (generic name risperidone) Atypical antipsychotic. Greatly reduces agitated depression/anxiety.
Does it work PRN? I have tried several AAP but not risperdal. The only one I remember gave me a calming effect was Geodon, which I gave up on too early, I slept a lot for a week but that was also due to depression. Some dose tweking had been a better idea.
Which makes me interested in Latuda, structurally close to Geodon and also Risperdal, but with even more favorable s/e profile, little to no prolactin (esp < 120mg) and no metabolic problems, with once a day dosing. I'm thinking of adding e g Latuda to my meds and take Lyrica as needed (if I can get it prescribed).> 4. Methoprazine (brand name Nozinan here in Canada) Hit/or/miss, but works when nothing else does.> 5. Have to mention choline again. It's been found to be very low in people with GAD/Panic Attacks.
I need to read up on these.
> I'd really take a shot at ketamine. It's not perfect, but is a very unique treatment.
Yeah, let's see what my doc says when she calls me. It's either that or Latuda I guess.
Side effects always scare with new medications, and Ketamine has some unique s/e for a couple of hours at least. I could do without the whole "tripping" experience./tensor
Posted by tensor on February 16, 2023, at 8:47:54
In reply to Re: Meds for severe anxiety » tensor, posted by Jay2112 on February 15, 2023, at 16:11:14
Had a call with my doc today so here's an update. Maybe it can be useful to someone in the future.
There is a consensus on my psychiatric hospital that pregabalin is not prescribed because of too many bad experiences. We started talking about alternatives like anti-psychotics, I suggested Latuda to take regularly but we agreed it's better to take an anti-psychotic as needed, since the severity of my anxiety increases in certain situations/circumstances. She said Latuda is too week, and she suggested Chlorprothixene which is an FGA. I already picked it up from the pharmacy and took a low dose of 15mg 30 minutes ago. I can already feel a nice calming effect but it's too early to tell how it will work for me, but it feels promising.
If you are in a similar situation, consider a medication like this./tensor
Posted by tensor on February 16, 2023, at 8:48:50
In reply to An update, posted by tensor on February 16, 2023, at 8:47:54
Posted by SLS on February 16, 2023, at 18:19:24
In reply to An update, posted by tensor on February 16, 2023, at 8:47:54
Hi, Tensor.
> Had a call with my doc today so here's an update. Maybe it can be useful to someone in the future.
> There is a consensus on my psychiatric hospital that pregabalin is not prescribed because of too many bad experiences. We started talking about alternatives like anti-psychotics, I suggested Latuda to take regularly but we agreed it's better to take an anti-psychotic as needed, since the severity of my anxiety increases in certain situations/circumstances. She said Latuda is too week, and she suggested Chlorprothixene which is an FGA. I already picked it up from the pharmacy and took a low dose of 15mg 30 minutes ago. I can already feel a nice calming effect but it's too early to tell how it will work for me, but it feels promising.
> If you are in a similar situation, consider a medication like this.
>
> /tensorNardil (phenelzine), an irreversible monoamine oxidase inhibitor (MAOI). It is perhaps the best treatment available for social anxiety / phobia. It is also effective to various degrees to treat GAD, Panic Disorder, and OCD.
Would you describe your anxiety as being the result of social phobia or social anxiety? If not, under what circumstances do you experience anxiety?
Some people use propranolol as a PRN to be taken before being exposed to an anxiety-provoking situation. It is sometimes used by people who engage in public speaking.
Which benzodiazepines have you tried? Your doctor is absolutely right with the way he portrays Lyrica (pregabalin). My experience with it was pretty bad. After my first few doses, it made me feel less depressed and somewhat calmer. However, after a few more days, I felt dysphoric and smothered by severe brain fog. I became numb to the world around me. After discontinuing Lyrica, it took three weeks for these mental aberrations to dissipate. The drug is unpredictable. I am going to suggest another unpredictable drug - Gabitril (tiagabine). Gabitril is a GABA reuptake inhibitor - the only drug of its type available. GABA is the most ubiquitous inhibitory neurotransmitter found in the brain, and offsets overactivity - anxiety. Some people report a positive outcome with Gabitril. However, it can also produce what is likely to be a disinhibition phenomenon that manifests as anger, irritability, agitation, hostility, and rage. Given your dwindling alternatives, I think Gabitril is worth a try. If you react badly to it, you will know quickly.
By the way, the GABA receptor is the site where benzodiazepines act to amplify GABA inhibitory (anti-anxiety) neurotransmission. The site where bendzodiazepines bind to is actually offset from the GABA binding site of the GABA receptor complex. It functions as a co-receptor to increase the sensitivity of the GABA receptor complex to the GABA neurotransmitter molecule.
- Scott
Posted by Jay2112 on February 16, 2023, at 20:19:20
In reply to An update, posted by tensor on February 16, 2023, at 8:47:54
> Had a call with my doc today so here's an update. Maybe it can be useful to someone in the future.
> There is a consensus on my psychiatric hospital that pregabalin is not prescribed because of too many bad experiences. We started talking about alternatives like anti-psychotics, I suggested Latuda to take regularly but we agreed it's better to take an anti-psychotic as needed, since the severity of my anxiety increases in certain situations/circumstances. She said Latuda is too week, and she suggested Chlorprothixene which is an FGA. I already picked it up from the pharmacy and took a low dose of 15mg 30 minutes ago. I can already feel a nice calming effect but it's too early to tell how it will work for me, but it feels promising.
> If you are in a similar situation, consider a medication like this.
>
> /tensorHi Tensor,
That is excellent you reacted well to Chlorprothixene!! I take a low dose of a FGA too, one called Nozinan (Methoprazine). It is a similar medication. It works excellent for me during stressful times, and Chlorprothixene should continue to work great for you. Studies have shown FGA's and SGA's are equal in treating symptoms of all sorts.
Let's see how this works, and I am very glad for you. I have been on methoprazine for over 20 years, with only small dose increases needed once in a while.
p.s. one suggestion I am not sure has been brought up is lamotragine. Antidepressants of every kind do not work for me (I am bipolar 2), and lamotragine brought me out of the dark. Antidepressants don't usually work in bipolar disorder.
Anyhow, one at a time, right? lol.
Best,
Jay
Posted by tensor on February 17, 2023, at 2:38:05
In reply to Re: An update » tensor, posted by Jay2112 on February 16, 2023, at 20:19:20
> Hi Tensor,
>
> That is excellent you reacted well to Chlorprothixene!! I take a low dose of a FGA too, one called Nozinan (Methoprazine). It is a similar medication. It works excellent for me during stressful times, and Chlorprothixene should continue to work great for you. Studies have shown FGA's and SGA's are equal in treating symptoms of all sorts.
>
> Let's see how this works, and I am very glad for you. I have been on methoprazine for over 20 years, with only small dose increases needed once in a while.
>
> p.s. one suggestion I am not sure has been brought up is lamotragine. Antidepressants of every kind do not work for me (I am bipolar 2), and lamotragine brought me out of the dark. Antidepressants don't usually work in bipolar disorder.
>
> Anyhow, one at a time, right? lol.
>
> Best,
> Jay
>
>Hi Jay and thank you!
Interesting to see that you use a similar medication with success. I have never had such a strong anxiolytic effect from an SGA. The only other FGA I have tried is sulpiride which had a mild effect.
I took 15mg last night and could feel it start working in 10 min. it had a nice anxiolytic effect from the start that continued to increase. After an hour I decided to take another dose just to see how I respond to it. After a couple of hours I was quite heavily sedated. Let's just say I had no trouble falling asleep for the night.
With an upper bound of 300mg I feel confident this medication can quell any anxiety and panicky feelings when traveling and other stressful situations. I feel really optimistic about the whole situation.Re lamotrigine, I have been on and off this med for many years and it's still difficult to gauge its efficacy for my (unipolar) depression. For anxiety it's more or less neutral. I'm currently off it. Highest dose was 200mg but tends to make me sleepy at that dose plus giving me headache.
Best regards
/tensor
Posted by tensor on February 17, 2023, at 4:28:18
In reply to Re: An update » tensor, posted by SLS on February 16, 2023, at 18:19:24
> Nardil (phenelzine), an irreversible monoamine oxidase inhibitor (MAOI). It is perhaps the best treatment available for social anxiety / phobia. It is also effective to various degrees to treat GAD, Panic Disorder, and OCD.
>
> Would you describe your anxiety as being the result of social phobia or social anxiety? If not, under what circumstances do you experience anxiety?
>
> Some people use propranolol as a PRN to be taken before being exposed to an anxiety-provoking situation. It is sometimes used by people who engage in public speaking.
>
> Which benzodiazepines have you tried? Your doctor is absolutely right with the way he portrays Lyrica (pregabalin). My experience with it was pretty bad. After my first few doses, it made me feel less depressed and somewhat calmer. However, after a few more days, I felt dysphoric and smothered by severe brain fog. I became numb to the world around me. After discontinuing Lyrica, it took three weeks for these mental aberrations to dissipate. The drug is unpredictable. I am going to suggest another unpredictable drug - Gabitril (tiagabine). Gabitril is a GABA reuptake inhibitor - the only drug of its type available. GABA is the most ubiquitous inhibitory neurotransmitter found in the brain, and offsets overactivity - anxiety. Some people report a positive outcome with Gabitril. However, it can also produce what is likely to be a disinhibition phenomenon that manifests as anger, irritability, agitation, hostility, and rage. Given your dwindling alternatives, I think Gabitril is worth a try. If you react badly to it, you will know quickly.
>
> - ScottHi Scott! Always nice to see a reply from you!
I have tried Parnate which worked for my depression and also had anxiolytic properties, esp for panic. That first golden week is possibly the closest I have been feeling "normal". But dose escalation and afternoon crashes rendered it useless over time. I have thought about Nardil and it's likely the most efficacious med out there for anxiety. However, MAOIs tend to lose efficacy over time and they are not without s/e. It's an option that remains on the table though.What makes me anxious about being away from home most likely (if not certainly) stems from panic disorder, I remember having panic attacks as a kid. Felt like I couldn't breathe and thought I was going to die and also had vertigo. Never told anyone, just kept it to myself, with the "logic" being, don't want doctors to find something is wrong with me, didn't know about panic disorder and thought it was something physiological and dangerous.
I regret this, it could have saved me from a lot of pain growing up. My social phobia, which appeared when I hit puberty, is still kept under control with clonazepam, I will never speak in front of people but I have no problems going to the grocery store for instance. In my late teens my SP was so bad I couldn't sit in a class room, clonazepam really fixed this. It's interesting and intriguing that other benzos were virtually useless for this (of the ones I have tried).I do use propranolol, it's in my arsenal :)
I have tried at least :
oxazepam
diazepam
alprazolam
lorazepam (Ok, IV after surgery so doesn't really count)
chlordiazepoxide
clonazepam
temazepam
nitrazepam for sleep
(zopiclone, zolpidem)I must be one of quite few people that prefer 30mg of oxazepam over diazepam and Xanax. I have a slight paradoxical effect from latter two. Some residual (or added?) anxiety that I don't feel on oxazepam or clonazepam. Maybe they are slightly activating? IIRC Xanax does something to NE.
Sorry to see you had a bad experience with Lyrica, it's really unpredictable as you said. I have read about people taking it for SP and GAD and had a really difficult time coming off it, one person had withdrawals for nine months. It's a shame it's such a poison (as my doc called it), its anxiolytic properties for me are great short-term. With short-term being the keyword here.
When I talked to my pdoc yesterday, she said she would arrange for me so that I could get a second opinion (more like 14th, but anyway) from another senior psychiatrist that I haven't met before. Will bring up Gabitril with him for sure, thanks for the tip. Could Trileptal be useful? So there may still be changes done to my regime before this is all said and done. My current psychiatric regime is:fluoxetine 60mg for depression and anxiety
clonazepam 2mg (will increase to 3 or 4mg for traveling) for SP, also GAD.
mirtazapine 7.5mg + nortriptyline 25mg, these two mainly to offset sexual s/e.
melatonin 5mg for sleepPRN chlorprothixene, propranolol, oxazepam, Seroquel (may discontinue this one). I sometimes take 15mg oxazepam with 25mg Seroquel for moderate anxiety producing situations, quite effective combo.
I say "psychiatric regime " because there other non-psychiatric medications I take regularly, here's a list:
1. omeprazole
----------------------------> By the way, the GABA receptor is the site where benzodiazepines act to amplify GABA inhibitory (anti-anxiety) neurotransmission. The site where bendzodiazepines bind to is actually offset from the GABA binding site of the GABA receptor complex. It functions as a co-receptor to increase the sensitivity of the GABA receptor complex to the GABA neurotransmitter molecule.
>Didn't know this, thanks for the info.
Wish you all the best, Scott!
/tensor
Posted by Lamdage22 on February 17, 2023, at 5:51:59
In reply to Re: An update » SLS, posted by tensor on February 17, 2023, at 4:28:18
I would get the Therapist involved, too. Talk things through. You don't want to be in medically induced coma during your holidays. Although you may benefit from certain medications.
What sort of Therapist?
Posted by tensor on February 17, 2023, at 6:03:46
In reply to Re: An update, posted by Lamdage22 on February 17, 2023, at 5:51:59
> I would get the Therapist involved, too. Talk things through.
Yeah, but I have doing this a long time, I had my first therapy session for panic disorder in the 90's. But I will likely start seeing one again.
You don't want to be in medically induced coma during your holidays. Although you may benefit from certain medications.
>True (except the flight, I wouldn't mind sleeping through it lol), but hopefully the excitement and adrenaline will offset sedation enough for it to be a rewarding experience. There is still time to find other remedies though, I'm starting to experiment now and we don't plan on traveling until next year. I'm happy I have found something anxiolytic that I feel I can count on if anxiety spins out of my control.
> What sort of Therapist?
CBT. Nurse or psychologist, not sure yet.
/tensor
Posted by Lamdage22 on February 17, 2023, at 9:44:17
In reply to Re: An update » Lamdage22, posted by tensor on February 17, 2023, at 6:03:46
Right, you wouldnt miss out if you slept for the duration of the flight.
Posted by Lamdage22 on February 17, 2023, at 9:48:00
In reply to Re: An update, posted by Lamdage22 on February 17, 2023, at 9:44:17
Do you have travel healthcare insurance? That may ease your mind
Posted by tensor on February 17, 2023, at 9:51:07
In reply to Re: An update, posted by Lamdage22 on February 17, 2023, at 9:48:00
> Do you have travel healthcare insurance? That may ease your mind
No but I will look it up, thanks for tip!
/tensor
Posted by undopaminergic on February 17, 2023, at 11:16:50
In reply to Re: An update » tensor, posted by Jay2112 on February 16, 2023, at 20:19:20
>
> That is excellent you reacted well to Chlorprothixene!! I take a low dose of a FGA too, one called Nozinan (Methoprazine).
>The first time I heard the name Nozinan, I thought it was something for the nose, maybe a decongestant.
Soon enough I learned it was an antipsychotic known as levomepromazine. Today is the first time I've heard the term methoprazine. Wikipedia doesn't mention that name at all, but does note that it is also known as methotrimeprazine.
I was offered it for sleep but never used it. When I mentioned concerns about residual sedation in the morning, they offered me chlorprothixene (Truxal). I never used that either, as it wasn't needed, but actually I'd like to try it for comparison with flupenthixol (Fluanxol), as they are structurally related, both belonging to the thioxanthene class of antipsychotics.
Flupenthixol has some antidepressive properties, but did not appear to work for me. I may try it again as part of combinations, as it may have a unique mechanism of action (it hasn't been elucidated to my knowledge) to contribute. It did not have any noticeable sedative or appetite-stimulant actions in my experience, but at higher doses, it gave me worse anorgasmia than SSRIs, and at one point (at more moderate doses) I was experiencing what seemed to be restless legs syndrome.
-undopaminergic
Posted by Lamdage22 on February 17, 2023, at 12:14:24
In reply to Re: An update » Lamdage22, posted by tensor on February 17, 2023, at 9:51:07
> > Do you have travel healthcare insurance? That may ease your mind
>
> No but I will look it up, thanks for tip!
>
> /tensorI never fly to other countries without it. If everything goes to sh*t, you can get help. Just knowing that reduces anxiety
Posted by SLS on February 17, 2023, at 21:25:04
In reply to Re: An update » SLS, posted by tensor on February 17, 2023, at 4:28:18
Hi, Tensor.
> > Nardil (phenelzine), an irreversible monoamine oxidase inhibitor (MAOI). It is perhaps the best treatment available for social anxiety / phobia. It is also effective to various degrees to treat GAD, Panic Disorder, and OCD.
> >
> > Would you describe your anxiety as being the result of social phobia or social anxiety? If not, under what circumstances do you experience anxiety?
> >
> > Some people use propranolol as a PRN to be taken before being exposed to an anxiety-provoking situation. It is sometimes used by people who engage in public speaking.
> >
> > Which benzodiazepines have you tried? Your doctor is absolutely right with the way he portrays Lyrica (pregabalin). My experience with it was pretty bad. After my first few doses, it made me feel less depressed and somewhat calmer. However, after a few more days, I felt dysphoric and smothered by severe brain fog. I became numb to the world around me. After discontinuing Lyrica, it took three weeks for these mental aberrations to dissipate. The drug is unpredictable. I am going to suggest another unpredictable drug - Gabitril (tiagabine). Gabitril is a GABA reuptake inhibitor - the only drug of its type available. GABA is the most ubiquitous inhibitory neurotransmitter found in the brain, and offsets overactivity - anxiety. Some people report a positive outcome with Gabitril. However, it can also produce what is likely to be a disinhibition phenomenon that manifests as anger, irritability, agitation, hostility, and rage. Given your dwindling alternatives, I think Gabitril is worth a try. If you react badly to it, you will know quickly.
> >
> > - Scott
> Hi Scott! Always nice to see a reply from you!You have no idea how good your timing is to say that.
> I have tried Parnate which worked for my depression and also had anxiolytic properties, esp for panic. That first golden week is possibly the closest I have been feeling "normal". But dose escalation and afternoon crashes rendered it useless over time. I have thought about Nardil and it's likely the most efficacious med out there for anxiety. However, MAOIs tend to lose efficacy over time and they are not without s/e. It's an option that remains on the table though.
I would say that MAOIs can stop working, but not nearly as often as SSRI do - "SSRI poop-out". In my estimation, Nardil is more likely to stop working than Parnate. However, there are plenty of people who continue to respond to Nardil for decades, or indefinitely. I'm into my third year of remission with the addition of Nardil to my treatment regime. I'll give some thought as to what you can do pharmacologically to help lower the risk of relapse while taking Nardil.
One absolutely crucial non-pharmacological treatment that will both make one more likely to respond to a medication and less likely to relapse while taking it is to REDUCE STRESS ON THE BRAIN. Most people are born with a brain that is mostly resilient to physiological stress. The grief that comes with the loss of a loved one does not usually precipitate a prolonged mental illness. One must be pre-disposed to a mental illness in order for normal challenges and psychosocial stress to trigger it. Brain function becomes persistently altered, although not always irreversibly. The dynamics of one's internal psyche is as much responsible for the severity of the stress placed on the brain as are the challenges encountered in the external environment. Given the same challenge, three people might demonstrate three different reactions, depending on how their psyche interprets the challenge. One gets happy. One gets sad. One gets anxious. This is the domain of psychotherapy.
1. Reduce psychosocial stress = Increases the probability of a treatment response.
2. Reduce psychosocial stress = Reduces the risk of a relapse.
* Tip: A trick that the first two generations of psychopharmacologists used when a patient relapsed while taking Nardil was to discontinue it temporarily - a "drug holiday" for a minimum of three months. Upon restarting Nardil, an antidepressant response can be "recaptured".
> What makes me anxious about being away from home most likely (if not certainly) stems from panic disorder, I remember having panic attacks as a kid. Felt like I couldn't breathe and thought I was going to die and also had vertigo. Never told anyone, just kept it to myself, with the "logic" being, don't want doctors to find something is wrong with me, didn't know about panic disorder and thought it was something physiological and dangerous.
> I regret this, it could have saved me from a lot of pain growing up. My social phobia, which appeared when I hit puberty, is still kept under control with clonazepam, I will never speak in front of people but I have no problems going to the grocery store for instance. In my late teens my SP was so bad I couldn't sit in a class room, clonazepam really fixed this. It's interesting and intriguing that other benzos were virtually useless for this (of the ones I have tried).
>
> I do use propranolol, it's in my arsenal :)
>
> I have tried at least :
> oxazepam
> diazepam
> alprazolam
> lorazepam (Ok, IV after surgery so doesn't really count)
> chlordiazepoxide
> clonazepam
> temazepam
> nitrazepam for sleep
> (zopiclone, zolpidem)
>
> I must be one of quite few people that prefer 30mg of oxazepam over diazepam and Xanax. I have a slight paradoxical effect from latter two. Some residual (or added?) anxiety that I don't feel on oxazepam or clonazepam. Maybe they are slightly activating? IIRC Xanax does something to NE.
> Sorry to see you had a bad experience with Lyrica, it's really unpredictable as you said. I have read about people taking it for SP and GAD and had a really difficult time coming off it, one person had withdrawals for nine months. It's a shame it's such a poison (as my doc called it), its anxiolytic properties for me are great short-term. With short-term being the keyword here.
> When I talked to my pdoc yesterday, she said she would arrange for me so that I could get a second opinion (more like 14th, but anyway) from another senior psychiatrist that I haven't met before. Will bring up Gabitril with him for sure, thanks for the tip. Could Trileptal be useful?- Trileptal: A "cleaner" version of Tegretol. It is not sedating the way Tegretol is and does not have the propensity to produce agranulocytosis. I don't know that it helps with a true anxiety disorder, but I haven't researched it. I would definitely look at any untried treatment as being a potential miracle. I liked Trileptal. I found it to be clean and somewhat energizing. If Trileptal were to work, it wouldn't be because it acts as a sedative or an anxiolytic. It would be because it helped to remodulate dyregulated systems upstream. It has the potential to produce hyponatremia as a side effect. It is not common, though. Unlike Tegretol, Trileptal can be combined with Lamictal without affecting each other's metabolism.
- Depakote: Has a mild anxiolytic effect in addition to its anticonvulsant, anti-manic, and mood stabilizing properties. It acts to increase GABA neurotransmission by blocking sodium channels. GABA inhibits and dampens excitatory tracts, and can reduce anxiety. I would use the word "smoothing" to describe how Depakite affected me. This smoothing effect always remained in the background, regardless of how it altered my mood and cognition. Depakote wouldn't be my first choice, but I wouldn't want to dissuade you from trying it. It might be your miracle.
- Lamictal: Is most often recommended to treat bipolar depression. I have a vague recollection that the rate of response to Lamictal was higher for bipolar depression than to unipolar depression. You'd have to check me on that. For depression, most people respond to 200 mg/day. For me, 300 mg/day is ideal.
> So there may still be changes done to my regime before this is all said and done. My current psychiatric regime is:
>
> fluoxetine 60mg for depression and anxiety
> clonazepam 2mg (will increase to 3 or 4mg for traveling) for SP, also GAD.
> mirtazapine 7.5mg + nortriptyline 25mg, these two mainly to offset sexual s/e.
> melatonin 5mg for sleep
Mine:Nardil - 90 mg/day
Nortriptyine - 100 mg/day
Lamictal - 300 mg/day
Lithium - 300 mg/dayGood luck.
- Scott
Posted by tensor on February 18, 2023, at 14:56:05
In reply to Re: An update » tensor, posted by SLS on February 17, 2023, at 21:25:04
Hi Scott!
> I would say that MAOIs can stop working, but not nearly as often as SSRI do - "SSRI poop-out". In my estimation, Nardil is more likely to stop working than Parnate. However, there are plenty of people who continue to respond to Nardil for decades, or indefinitely. I'm into my third year of remission with the addition of Nardil to my treatment regime. I'll give some thought as to what you can do pharmacologically to help lower the risk of relapse while taking Nardil.That's nice to hear, I hope you will continue to do well on Nardil. I remember one guy on this forum had a strategy re MAOIs, or maybe it was a friend of his, anyway, he switched between Nardil and Parnate, like when Nardil stopped working or the response was not enough he switched to Parnate, and then back to Nardil when it happened again and so on. You are probably aware of this but I brought it up just in case. May work for some people. I think I would love the anxiolytic effect of Nardil, and since I've been on Parnate, the idea of taking an MAOI doesn't scare me. I'm more concerned about sexual s/e for instance, which I have read can be quite severe.
> One absolutely crucial non-pharmacological treatment that will both make one more likely to respond to a medication and less likely to relapse while taking it is to REDUCE STRESS ON THE BRAIN. Most people are born with a brain that is mostly resilient to physiological stress. The grief that comes with the loss of a loved one does not usually precipitate a prolonged mental illness. One must be pre-disposed to a mental illness in order for normal challenges and psychosocial stress to trigger it. Brain function becomes persistently altered, although not always irreversibly. The dynamics of one's internal psyche is as much responsible for the severity of the stress placed on the brain as are the challenges encountered in the external environment. Given the same challenge, three people might demonstrate three different reactions, depending on how their psyche interprets the challenge. One gets happy. One gets sad. One gets anxious. This is the domain of psychotherapy.
> 1. Reduce psychosocial stress = Increases the probability of a treatment response.
2. Reduce psychosocial stress = Reduces the risk of a relapse.
> * Tip: A trick that the first two generations of psychopharmacologists used when a patient relapsed while taking Nardil was to discontinue it temporarily - a "drug holiday" for a minimum of three months. Upon restarting Nardil, an antidepressant response can be "recaptured".
Yes, I agree to some extent. I think it was in 2016 I gave up fighting to stay in working life. My application for disability pension was approved. I thought that this will give my mind some time to heal, since my focus uptil then had solely been to get back to work asap. Since my mental energy was never par for the course for working, even part time, it felt like a huge yoke had been lifted off my shoulders. I would for several years only do things I wanted to do. However, since then, seven years later, I have never had a period in remission where I felt like I could work, not even part time, well maybe for a day or two but not for a week or longer. It just doesn't happen anymore. My doc compared this to a beaten path in the jungle, whatever happened in my brain during depression would be more likely to happen again.
The pattern is pretty clear. When I was working, the length in remission got shorter and the length of my sick leaves got longer. Does it qualify for some kind of brain damage? Could it have been avoided? I don't know, my depression has always felt very "biological", i e stemming from internal factors. Like it feels like it would have happened regardless if I was living a hypothetical stressless life in the jungle eating bananas the whole day.
There is no moral to this story, just a reflection.
-------------------
There's more to this, from an evolutionary perspective, looking at nature, to me it seems a single individual is not important enough. It's all about the survival of the species, a lot - if not everything - in nature revolves around reproducing, incredible amount of sperm cells are produced everyday for example. A single individual can be sacrificed. So an individual in nature - before we had developed any kind of medicine - has some mechanisms to stay alive, we can heal a small wound, but we can't regenerate limbs, if a lung gets punctured or we brake an arm or a leg, we are done, dead. Hopefully we already managed to produce an offspring. If you are born with some form of defect, tough luck, you are not gonna make it.
This makes me wonder why nature would provide us with mechanims to heal a severe depression or any other serious mental disorder, in nature we would just die off. Today we have therapies in different forms and we carry each other, so a person with a disability can have a meaningful life instead of starving to death in the forest. Medication can mask/relieve symptoms of severe psychosis or depression, but do we have inbuilt mechanisms to allow our brains to rewire themselves and become healthy and/or more resilient? I don't see why we would have, a single individual is not that important from nature's perspective. Not to be a downer, it's just how I look at it as a layman, I'm gladly proven wrong and I felt like ranting (sorry).> - Trileptal: A "cleaner" version of Tegretol. It is not sedating the way Tegretol is and does not have the propensity to produce agranulocytosis. I don't know that it helps with a true anxiety disorder, but I haven't researched it. I would definitely look at any untried treatment as being a potential miracle. I liked Trileptal. I found it to be clean and somewhat energizing. If Trileptal were to work, it wouldn't be because it acts as a sedative or an anxiolytic. It would be because it helped to remodulate dyregulated systems upstream. It has the potential to produce hyponatremia as a side effect. It is not common, though. Unlike Tegretol, Trileptal can be combined with Lamictal without affecting each other's metabolism.
- Depakote: Has a mild anxiolytic effect in addition to its anticonvulsant, anti-manic, and mood stabilizing properties. It acts to increase GABA neurotransmission by blocking sodium channels. GABA inhibits and dampens excitatory tracts, and can reduce anxiety. I would use the word "smoothing" to describe how Depakite affected me. This smoothing effect always remained in the background, regardless of how it altered my mood and cognition. Depakote wouldn't be my first choice, but I wouldn't want to dissuade you from trying it. It might be your miracle.
- Lamictal: Is most often recommended to treat bipolar depression. I have a vague recollection that the rate of response to Lamictal was higher for bipolar depression than to unipolar depression. You'd have to check me on that. For depression, most people respond to 200 mg/day. For me, 300 mg/day is ideal.
Thank you for the information! I remember when I took Lamictal the first time, it had a slight disinhibitory effect, maybe there was something that happened because of clonazepam, some synergy. Anyway, it was quite pleasant, always wondered if Trileptal would feel like that but stronger, is it something you've noticed? It's difficult to explain it, but the closest is possibly the social feeling you get from a small amount of alcohol. I don't think Lamictal otherwise ever did anything for my depression. As it stands, there's room for one more medication, tiagabine as you mentioned earlier or perhaps Trileptal.
Valproate looks absolutely horrible on paper, like clozapine in terms of potential and dangerous side effects. How bad is it in real life?> Mine:
Nardil - 90 mg/day
Nortriptyine - 100 mg/day
Lamictal - 300 mg/day
Lithium - 300 mg/dayThat's a solid combo!
> Good luck.
Good luck to you too!/tensor
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