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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by SLS on May 5, 2000, at 12:42:30
Hi John,
I noticed your post on another thread that is pertinent to my case.
I could use your help on this one.
> The phenomenon you mention--quick response which then fades or worsens--is a clue indicative of instable chemistry or instable electricity. This phenomenon is clearly identified and discussed in a book I was reading. Not just a case of chemical imbalance. And this of course warrants a whole new approach in drug selection priorities.
This has been my story since I was first tried on imipramine in 1982. Both tricyclics and MAO inhibitors produce a significant improvement at about the two week mark. The response lasts for 2-3 days and then disappears abruptly. How might this be interpreted by Dr. Jensen, and how does he recommend treating it?
Many, many, many thanks!
- Scott
Posted by JohnL on May 6, 2000, at 4:41:22
In reply to JohnL - Help!, posted by SLS on May 5, 2000, at 12:42:30
> Hi John,
>
> I noticed your post on another thread that is pertinent to my case.
>
> I could use your help on this one.
>
> > The phenomenon you mention--quick response which then fades or worsens--is a clue indicative of instable chemistry or instable electricity. This phenomenon is clearly identified and discussed in a book I was reading. Not just a case of chemical imbalance. And this of course warrants a whole new approach in drug selection priorities.
>
> This has been my story since I was first tried on imipramine in 1982. Both tricyclics and MAO inhibitors produce a significant improvement at about the two week mark. The response lasts for 2-3 days and then disappears abruptly. How might this be interpreted by Dr. Jensen, and how does he recommend treating it?
>
> Many, many, many thanks!
>
>
> - ScottScott,
I can't speak for Dr Jensen or my own doctor as to exactly what drugs you should be looking at, or in what order to try them. But I can venture an educated guess, based on what I know of their approaches.The quick response which then fades falls into the protocol of unstable chemistry. This is usually corrected with one of the anticonvulsants. Choices are Depakote, Tegretal, Lamictal, Neurontin. But an antipsychotic might work well too, because some of them have mood stabilizing properties which have really started showing up in literature in the last month or so. Zyprexa in particular has been creating quite a buzz as both an antidepressant and a mood stabilizer. A substitute with less sedation and less weight gain is Risperdal, and sometimes Stelazine. If it is electrical instability with or without chemical instability, then Lithium would be the one. But we don't know at this point which it is. The clues provided by previous drug trials point in this direction though.
I was in your shoes exactly. My doctor (not Jensen, but used Jensen's method) prescribed Depakote, Tegretal, and Neurontin for one to two weeks each. My choice. Then choose a favorite for a longer trial. I found no benefit in any of them. Had already tried Lamictal previously. Had already tried Lithium. The next step was the antipsychotic class. I was to try Zyprexa, Risperdal, and Stelazine for one to two weeks each, and choose a favorite to continue. Well, I was surprised to find at day 2 I responded very nicely to Zyprexa. I never even went on to compare the others.
The good results continued as the trial got longer. It was pretty cool that it didn't fade. But the sedation really really got to me. Instead of backtracking and picking up where we left off--comparing Risperdal and Stelazine instead--I opted to try Amisulpride instead. It is similar to Stelazine. But I think it has fewer, if any, side effects and more specific action. Not easy or cheap to get though. That's a real hurdle with Amisulpride. On Amisulpride I noticed benefits during the beginning of week 2. And it has continued ever since.
But that's just my story and my chemistry. I would guess with some accuracy that my own doc or Dr Jensen would very likely follow the same path. Anticonvulsants first, antipsychotics next. One to two weeks each. Choose the best overall for a longer look-see. Hope this helps in adding some structure to your dilemma. And as a final note, I think they would have you continue your favorite choice of antidepressant during the entire procedure. You would be looking to stabilize your favorite antidepressant with an anticonvulsant, lithium, or an antipsychotic.
JohnL
Posted by SLS on May 6, 2000, at 9:01:43
In reply to Re: SLS - Protocol for Unstable Chemistry, posted by JohnL on May 6, 2000, at 4:41:22
Thanks John. I appreciate your taking the time to answer my plea for help. I am feeling worse, becoming more vegetative, and losing my ability to read and think. No more intellectual stuff for a while, I guess.
Much of what you have described seems to ring true with me.
Your comment regarding lithium has got me thinking about trying it again. I hate that damned drug. Even at 600mg/day, I feel washed-out, flat, and passified. Unfortunately, I guess it might be the only drug to fill the role. I really should have given it a short trial the last time I was taking Parnate + a tricyclic. Lithium is supposed to be a good augmenter of Parnate.
I am considering performing a brief trial of adding Neurontin to the Lamictal 300mg I am currently taking. I would like to stay with low dosages, hopefully between 900-1200mg. The first time I tried it, higher dosages produced intolerable cognitive effects. I would not spend any more than two weeks with this. Some of the newer anticonvulsants have been suggested for me to take a look at, namely tiagabine (Gabitril).
I am having a difficult time deciding on whether to return to Parnate immediately or try some other things first. One of the big questions I am working with is what I will be able to add to Parnate. Have you ever heard of either amisulpride or adrafinil/modafinil being combined with Parnate? I think it makes sense to try other things first, as to start with Parnate and add things to it represents a committment of a huge amount of time.
I do like the idea of using short trials with stimulants, neuroleptics, lithium, and anticonvulsants when treating depression, particularly when they are being added to an antidepressant. To create the sort of structure you are suggesting makes a great deal of sense to me, and I will try to employ it.
Please, if you can think of anything else, I would be most grateful if you would post or contact me via e-mail.
Thanks.
sl.schofield@worldnet.att.net
- Scott
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