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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 134 to 158 of 201. Go back in thread:
Posted by Conundrum on October 18, 2011, at 7:38:27
In reply to Re: Viibrid Treatment » Conundrum, posted by SLS on October 18, 2011, at 6:01:05
> > > Hello Conundrum.
> > >
> > > Long time - no see.
> > >
> > >
> > > > So the results you experienced initially are no longer there, or you just have not seen an improvement from that level of improvement?
> > >
> > > Good question.
> > >
> > > The improvement that I received initially remains intact for now. I had only one setback a few days ago. Otherwise, things are stable. I know when things are heading in the right direction. I know what a high-quality antidepressant response feels like. There is something missing for me right now. Anhedonia and brain-fog are still unremitting.
> > >
> > >
> > > - Scott
> > >
> > >
> >
> > Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
>
>
> Yes, although it was much reduced. When I responded so well to Parnate + desipramine, the brain-fog was totally absent. It was also absent for a few weeks the first time I took Nardil 60mg.
>
> Damned brain.
>
>
> - Scott
>Interesting. I find that Nardil has the opposite effect for me. Do your BP meds contribute to these symptoms at all?
Posted by SLS on October 18, 2011, at 8:38:28
In reply to Re: Viibrid Treatment » SLS, posted by Conundrum on October 18, 2011, at 7:38:27
> > > > There is something missing for me right now. Anhedonia and brain-fog are still unremitting.
> > > Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
> > Yes, although it was much reduced. When I responded so well to Parnate + desipramine, the brain-fog was totally absent. It was also absent for a few weeks the first time I took Nardil 60mg.
> Interesting. I find that Nardil has the opposite effect for me. Do your BP meds contribute to these symptoms at all?
Not at present, although I have experienced brain-fog as a side effect with Zoloft, Neurontin, Lyrica, and Geodon (to name a few).
- Scott
Posted by floatingbridge on October 18, 2011, at 12:39:22
In reply to Re: Viibrid Treatment » Conundrum, posted by SLS on October 18, 2011, at 8:38:28
> > > > Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
>
> > > Yes, although it was much reduced. When I responded so well to Parnate + desipramine, the brain-fog was totally absent. It was also absent for a few weeks the first time I took Nardil
>
>
> - ScottScott, is it possible that adding a little amphetamine would help clear some of the anhedonia and fog? I think I recall you saying once you were not very responsive to stimulants. Looking at the above about parnate and the beginning of nardil, I wonder if there would be any benefit in retrying a small amount. Maybe rotating days on and off, if it indeed worked, might help trick your brain from growing too accustomed. Hang in there with this.
fb
Posted by SLS on October 18, 2011, at 13:14:03
In reply to Re: Viibrid Treatment » SLS, posted by floatingbridge on October 18, 2011, at 12:39:22
> > > > > Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
> >
> > > > Yes, although it was much reduced. When I responded so well to Parnate + desipramine, the brain-fog was totally absent. It was also absent for a few weeks the first time I took Nardil
> >
> >
> > - Scott
>
> Scott, is it possible that adding a little amphetamine would help clear some of the anhedonia and fog? I think I recall you saying once you were not very responsive to stimulants. Looking at the above about parnate and the beginning of nardil, I wonder if there would be any benefit in retrying a small amount. Maybe rotating days on and off, if it indeed worked, might help trick your brain from growing too accustomed. Hang in there with this.
I guess I could try it. I have nearly a full vial of Dexedrine from my last unsuccessful trial performed last year.Tbanks for the suggestion.
- Scott
Posted by SLS on October 19, 2011, at 6:31:00
In reply to Re: Viibrid Treatment » floatingbridge, posted by SLS on October 18, 2011, at 13:14:03
Well, it looks as though Viibryd will not be my magic potion. I am losing more ground each day as my depressive illness asserts itself. My guess is that the improvement I experienced over the course of the first few weeks was actually an effect due to the discontinuation of Nardil. It has happened to me before that discontinuing Nardil has produced a withdrawal-rebound improvement that lasts 2-3 weeks. It is possible that Viibryd "piggy-backed" this rebound effect and may have caused me to feel genuinely better temporarily.
I intend to keep taking Viibryd for a few weeks. I guess you never know what can happen with these drugs. My guess is that I will end up switching from Viibrid to either Effexor or Pristiq and just accept that I will be denied a life without depression - at least until there are new drugs and new understandings. Not fun.
http://www.ncbi.nlm.nih.gov/pubmed/12776393
http://www.ncbi.nlm.nih.gov/pubmed/3435883
- Scott
Posted by europerep on October 19, 2011, at 8:39:29
In reply to Re: Viibrid Treatment, posted by SLS on October 19, 2011, at 6:31:00
Hello Scott,
to be honest, what I don't understand is why you don't consider participating in clinical trials for more novel agents. (Or, if you do, you never talk about it.) There are a bunch of trials going on in the US for ketamine in TRD, either intravenous or intranasal. If you profited from it, you could still get it from the black market if the doctors refused to give it to you on a regular basis. If you're afraid of legal trouble, try methoxetamine, which is an unregulated substance somewhat similar to ketamine.
I know you are very patient, but I'm wondering whether you may actually be *too* patient. After trying out I-don't-know-how-many drugs that act on 5HT/NE/DA, I would conclude that it's time to look elsewhere. Buprenorphine may be worth trying as well.
Just my thoughts...
ER
Posted by SLS on October 19, 2011, at 13:05:11
In reply to Re: Viibrid Treatment » SLS, posted by europerep on October 19, 2011, at 8:39:29
> Hello Scott,
>
> to be honest, what I don't understand is why you don't consider participating in clinical trials for more novel agents.I did a lot of that in the 80s and 90s. I am not too keen on discontinuing everything I am currently taking in order to participate in a clinical trial. I would certainly try something new were there to be compelling results already established. The other thing to consider is that most of these investigations exclude me from consideration because of my bipolar history.
> There are a bunch of trials going on in the US for ketamine in TRD, either intravenous or intranasal.
I'll look into that. I know there is at least one compound being developed that works like ketamine, but without the euphoria. I don't remember the name of it.
> If you profited from it, you could still get it from the black market if the doctors refused to give it to you on a regular basis.
I had thought of that, but I wouldn't know where to get it. Unfortunately, the window for ketamine is very, very narrow. It might be a difficult drug to dose properly.
> If you're afraid of legal trouble, try methoxetamine, which is an unregulated substance somewhat similar to ketamine.
Thanks for the lead. I had never heard of it. I see on Wiki that methoxetamine is also a dopamine reuptake inhibitor. Just what the doctor ordered.
> I know you are very patient, but I'm wondering whether you may actually be *too* patient.
I certainly wish that I hadn't spent this past year taking Nardil. I felt encouraged to do so based upon the occurrence of a second wave of improvements that occurred last December.
> After trying out I-don't-know-how-many drugs that act on 5HT/NE/DA, I would conclude that it's time to look elsewhere. Buprenorphine may be worth trying as well.
The last time I asked my doctor about buprenorphine, he refused to work with it.
> Just my thoughts...
Good ones. Thanks.
I will definitely keep them in mind. I think you are right about me having to look elsewhere for help.
I would like to have seen the triple reuptake inhibitors rise up through Phase III trials. They seem to have been dropped.
http://www.neurotransmitter.net/newdrugs.html
- Scott
Posted by zonked on October 19, 2011, at 13:42:00
In reply to Re: Viibrid Treatment » europerep, posted by SLS on October 19, 2011, at 13:05:11
Scott,
What did Dexedrine do to you? Most people feel better within 30 minutes. No effect, anxiety...?
Just curious. I would think with your treatment history, buprenorphine would be a logical choice if you have one or two more failed trials.
If your doctor knows your history, he knows you're not an "addict" - you just desperately want relief. If he was concerned about addiction potential, couldn't he prescribe you a week's worth and follow up with you? Just an idea. I know it's worse than pulling teeth to get docs to try opiods for depression.
Have you ever had pain so severe to warrant a Vicodin prescription? I am not suggesting that you bring up Vicodin, it's not an appropriate agent (tylenol, conventional opiod); but was wondering if you feel the AD response so many of us do when taking that. I have severe migraines about twice a year, and always flux on whether or not to accept a Vicodin RX because it's sort of a tease. (If you know what I mean.)
-z
Posted by markwell on October 19, 2011, at 15:12:26
In reply to Re: Viibrid Treatment, posted by SLS on October 19, 2011, at 6:31:00
Scott, I'm in the same boat with you. I'm going to try to stay with viibryd but my anxiety is off the charts. Did you get any anxiety relief with viibryd? I'm only 2 days at 20mgs so I don't know if it will improve my depression. I feel for you.
Mark
Posted by SLS on October 19, 2011, at 15:24:04
In reply to Re: Viibrid Treatment, posted by markwell on October 19, 2011, at 15:12:26
> Scott, I'm in the same boat with you. I'm going to try to stay with viibryd but my anxiety is off the charts. Did you get any anxiety relief with viibryd?
Viibryd definitely caused me to experience mild to moderate anxiety while I was titrating up to 40mg. I think there is a tendency for this drug to increase anxiety rather than decrease it. Until someone responds very well to Viibryd, we won't know if this anxiety disappears with time or is a sign that it won't work.
> I'm only 2 days at 20mgs so I don't know if it will improve my depression.
I'll have to speak to my doctor again. He said that it takes longer to respond to Viibryd than to other antidepressants.
Make sure you impress upon your doctor how severe your anxiety is. Perhaps he will give you something to reduce it temporarily. This was a common practice with Prozac when it was discovered that it was producing anxiety as a side effect at the beginning of treatment.
- Scott
Posted by floatingbridge on October 19, 2011, at 17:35:01
In reply to Re: Viibrid Treatment » markwell, posted by SLS on October 19, 2011, at 15:24:04
The anxiety is really too bad. And contrary to what the wiki entry suggests. Though the entry is likely based on theory. Still, I am surprised. And of course I had been wishing what wiki wrote up was true irl.
Well, very best to both of you Markwell and Scott.
Posted by Phillipa on October 19, 2011, at 19:12:20
In reply to Re: Viibrid Treatment » SLS, posted by floatingbridge on October 19, 2011, at 17:35:01
Good and bad reviews. More positive than negative. Just info as all different. Phillipa
Posted by SLS on October 20, 2011, at 8:50:53
In reply to Re: Viibrid Treatment » SLS, posted by floatingbridge on October 19, 2011, at 17:35:01
> The anxiety is really too bad. And contrary to what the wiki entry suggests. Though the entry is likely based on theory. Still, I am surprised. And of course I had been wishing what wiki wrote up was true irl.
>
> Well, very best to both of you Markwell and Scott.
Thanks, FB.Today, I have recovered much of the antidepressant response that had been absent over the last few days. Perhaps this is a good sign.
- Scott
Posted by Conundrum on October 20, 2011, at 9:13:21
In reply to Re: Viibrid Treatment » floatingbridge, posted by SLS on October 20, 2011, at 8:50:53
> > The anxiety is really too bad. And contrary to what the wiki entry suggests. Though the entry is likely based on theory. Still, I am surprised. And of course I had been wishing what wiki wrote up was true irl.
> >
> > Well, very best to both of you Markwell and Scott.
>
>
> Thanks, FB.
>
> Today, I have recovered much of the antidepressant response that had been absent over the last few days. Perhaps this is a good sign.
>
>
> - ScottI think it was Bleauberry who said that often recovery is up and down. Hang in there.
Posted by morgan miller on October 20, 2011, at 9:31:51
In reply to Re: Viibrid Treatment » floatingbridge, posted by SLS on October 20, 2011, at 8:50:53
Maybe there will be a waxing and waning of sorts before a more steady response occurs. Hopefully.
Posted by SLS on October 20, 2011, at 11:18:37
In reply to Re: Viibrid Treatment » SLS, posted by morgan miller on October 20, 2011, at 9:31:51
You guys are right. It is just that I am at that point in time that any left-over Nardil improvement would disappear. If, in another week, I am still experiencing any kind of improvement at all, even if episodic, I would be very encouraged and assume the best. At that point, I would see the peaks and valleys as a typical pattern of recovery for me.
For his patients, Dr. Robert M. Post once drew a graph on a piece of scrap paper using a pencil depicting an ascending saw-tooth line. This was to represent the pattern of recovery that they often saw in research patients at the NIH. I expect that my recovery will follow the same saw-tooth pattern.
This is a bit of an emotional rollercoaster ride. Feeling better as I do now, I have plenty of justification to continue with Viibryd for several more weeks before evaluating its effectiveness. I will try to be patient.
Thanks for your support.
- Scott
Posted by morgan miller on October 20, 2011, at 11:44:12
In reply to Re: Viibrid Treatment » morgan miller, posted by SLS on October 20, 2011, at 11:18:37
Hang in there Scott. I'm hoping for the best man, you deserve it.
Morgan
Posted by Chairman_MAO on October 24, 2011, at 21:04:46
In reply to Re: Viibrid Treatment » europerep, posted by SLS on October 19, 2011, at 13:05:11
> I'll look into that. I know there is at least one compound being developed that works like ketamine, but without the euphoria. I don't remember the name of it.
Memantine? If that's what you're thinking of, it's already been developed and if you haven't tried it you might want to consider giving it a go.
Best of luck.
Posted by SLS on October 25, 2011, at 19:07:42
In reply to Re: Viibrid Treatment » SLS, posted by Chairman_MAO on October 24, 2011, at 21:04:46
> > I'll look into that. I know there is at least one compound being developed that works like ketamine, but without the euphoria. I don't remember the name of it.
>
> Memantine? If that's what you're thinking of, it's already been developed and if you haven't tried it you might want to consider giving it a go.
>
> Best of luck.
Thanks.I tried memantine once. I still have some left. It didn't help at 20mg when combined with Parnate, but it didn't hurt, either. I was reluctant to push it to 40mg because I felt drunk the first day I added an extra 20mg dose.
I might ask my doctor again about buprenorphine. He was not at all interested the first time I brought up the subject. I would prefer to try a few more things before heading down that road.
- Scott
Posted by SLS on October 27, 2011, at 5:15:11
In reply to Re: Viibrid Treatment » Chairman_MAO, posted by SLS on October 25, 2011, at 19:07:42
Damn it.
I have been stuck for the past few days. I lost a significant amount of the improvement that Viibryd had given me. I was excited there for a little while, especially when I began to experience boredom. Right now, I have little hope that this stuff will work. Of course, I could be pleasantly surprised and begin feeling better once again.
This next 7 days is critical. I believe that this is the window of time within which any true antidepressant response to Viibryd should appear more robustly. I can't yet conclude with certainty that the drug won't work, but I am not very hopeful. As I've said before, I have the patience to continue taking Viibryd, but not the patience to remain optimistic.
- Scott
Posted by floatingbridge on October 27, 2011, at 6:42:53
In reply to Re: Viibrid Treatment, posted by SLS on October 27, 2011, at 5:15:11
Scott, it's saw teeth. I hear the colors are not their best this autumn. Maybe go for a ride somewhere lovely. If weather permits, shuffle through some leaves. They have a distinctive smell. Not the same here at all. Smell is primitive. I'd love you to be surprised.
Posted by SLS on October 28, 2011, at 7:11:29
In reply to Re: Viibrid Treatment, posted by SLS on October 27, 2011, at 5:15:11
I continue to deteriorate.Has anyone found 80mg to be more effective than 40mg?
- Scott
> Damn it.
>
> I have been stuck for the past few days. I lost a significant amount of the improvement that Viibryd had given me. I was excited there for a little while, especially when I began to experience boredom. Right now, I have little hope that this stuff will work. Of course, I could be pleasantly surprised and begin feeling better once again.
>
> This next 7 days is critical. I believe that this is the window of time within which any true antidepressant response to Viibryd should appear more robustly. I can't yet conclude with certainty that the drug won't work, but I am not very hopeful. As I've said before, I have the patience to continue taking Viibryd, but not the patience to remain optimistic.
Posted by SLS on October 29, 2011, at 20:25:00
In reply to Viibrid Treatment - Anyone have success at 80mg ?, posted by SLS on October 28, 2011, at 7:11:29
I am experiencing an intensification of depression and anxiety. I think I feel worse now than I did before starting Viibryd. I am thinking about aborting the trial.
- Scott
Posted by Conundrum on October 29, 2011, at 20:32:48
In reply to Re: Viibrid Treatment - Anyone have success at 80mg ?, posted by SLS on October 29, 2011, at 20:25:00
> I am experiencing an intensification of depression and anxiety. I think I feel worse now than I did before starting Viibryd. I am thinking about aborting the trial.
>
>
> - ScottPerhaps you felt better at 20mg in the beginning? I felt better on 50mg pristiq than 100mg even though you'd think more is better. Sometimes more is more numbing or has more side effects and it becomes a wash.
Posted by SLS on October 29, 2011, at 20:46:05
In reply to Re: Viibrid Treatment - Anyone have success at 80mg ?, posted by Conundrum on October 29, 2011, at 20:32:48
> > I am experiencing an intensification of depression and anxiety. I think I feel worse now than I did before starting Viibryd. I am thinking about aborting the trial.
> >
> >
> > - Scott
>
> Perhaps you felt better at 20mg in the beginning? I felt better on 50mg pristiq than 100mg even though you'd think more is better. Sometimes more is more numbing or has more side effects and it becomes a wash.
Since I have an appointment to see my doctor in two days, I think I'll skip tomorrow's dose.Which drug do you think is more effective for you: Pristiq or Effexor?
Thanks.
- Scott
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