![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Else on July 20, 2001, at 14:19:08
Right now I am freaking out a little bit because I'm turning into a nervous wreck again. I have a very high tolerance for sedatives and after a week on 2mg Klonopin daily I am back to being a nervous wreck. It should be noted that I also take 900mg Neurontin in addition to this. Now I used to feel OK a few days ago (and not drowsy at all mind you) but now I'm getting all worked up over nothing again. I recently (two weeks ago) stopped taking Wellbutrin because I didn't think it was helping at all and because it gave me those annoying tremors but now I am not so sure it was a good idea. When my doc asked what dose of Klonopin I though would be O.K. I said 2mg even though I really though three would be better (didn't want to look like one of 'em drug addicts, you know). Anyway. Now my doc is on vacation and I have to work next week and I am bouncing off the walls. Is this due to depression rearing it's ugly head because I dropped the Wellbutrin ( I'm ruminating but not really depressed at this point)? Should I go back on the Wellbutrin? Increase the Klonopin to 3mg like I though would be best from the beginning? What?
And while I'm at it. This is a question for all of you anxious/dysthymic people out there. What have you found works best. Years ago I was on a combo of Prozac and Xanax for 6 weeks but it's kind of blurry now. Are there other drugs that would have the same effect as Wellbutrin (non-serotoninergic, very important), without the tremors? Any ideas? Suggestions? I don't know what to do anymore. I don't want depression and I certainly don't want anxiety (nor anticholinergic effects and the like...) Am I asking to much?
I've tried:
Prozac (20mg die), Xanax (0.25mg tid), Zoloft (100mg die), Depakote (500mg tid), Effexor (300mg die), Wellbutrin (150mg bid) Neurontin (300mg tid) and now Klonopin (0.5 bid + 1.0 HS). I found that anti-convulsants were useless, that drugs that enhanced my mood made me more anxious (Effexor & Wellbutrin)and that drug that made me less anxious made me more depressed (tranquilizers). So now what. Please somebody help.
Posted by Edward on July 20, 2001, at 15:18:29
In reply to What do I do now?, posted by Else on July 20, 2001, at 14:19:08
>Are there other drugs that would have the same effect as Wellbutrin (non-serotoninergic, very important
Reboxetine is non-serotonergic. I think it's the only noradrenaline reuptake inhibitor.
Posted by Else on July 20, 2001, at 16:04:42
In reply to Re: What do I do now?, posted by Edward on July 20, 2001, at 15:18:29
> >Are there other drugs that would have the same effect as Wellbutrin (non-serotoninergic, very important
>
> Reboxetine is non-serotonergic. I think it's the only noradrenaline reuptake inhibitor.Thanks but, I'm not sure this is availlable in Canada although it should be. Maybe Desipramine would be a good alternative. I don't know much about TCAs though.
Posted by SalArmy4me on July 21, 2001, at 1:38:53
In reply to What do I do now?, posted by Else on July 20, 2001, at 14:19:08
Have you tried nefazodone? http://www.vh.org/Providers/Conferences/CPS/16.html
Posted by jojo on July 21, 2001, at 3:10:11
In reply to What do I do now?, posted by Else on July 20, 2001, at 14:19:08
> Right now I am freaking out a little bit because I'm turning into a nervous wreck again. I have a very high tolerance for sedatives and after a week on 2mg Klonopin daily I am back to being a nervous wreck. It should be noted that I also take 900mg Neurontin in addition to this. Now I used to feel OK a few days ago (and not drowsy at all mind you) but now I'm getting all worked up over nothing again. I recently (two weeks ago) stopped taking Wellbutrin because I didn't think it was helping at all and because it gave me those annoying tremors but now I am not so sure it was a good idea. When my doc asked what dose of Klonopin I though would be O.K. I said 2mg even though I really though three would be better (didn't want to look like one of 'em drug addicts, you know). Anyway. Now my doc is on vacation and I have to work next week and I am bouncing off the walls. Is this due to depression rearing it's ugly head because I dropped the Wellbutrin ( I'm ruminating but not really depressed at this point)? Should I go back on the Wellbutrin? Increase the Klonopin to 3mg like I though would be best from the beginning? What?
>
> And while I'm at it. This is a question for all of you anxious/dysthymic people out there. What have you found works best. Years ago I was on a combo of Prozac and Xanax for 6 weeks but it's kind of blurry now. Are there other drugs that would have the same effect as Wellbutrin (non-serotoninergic, very important), without the tremors? Any ideas? Suggestions? I don't know what to do anymore. I don't want depression and I certainly don't want anxiety (nor anticholinergic effects and the like...) Am I asking to much?
>
> I've tried:
>
> Prozac (20mg die), Xanax (0.25mg tid), Zoloft (100mg die), Depakote (500mg tid), Effexor (300mg die), Wellbutrin (150mg bid) Neurontin (300mg tid) and now Klonopin (0.5 bid + 1.0 HS). I found that anti-convulsants were useless, that drugs that enhanced my mood made me more anxious (Effexor & Wellbutrin)and that drug that made me less anxious made me more depressed (tranquilizers). So now what. Please somebody help.I don't see that you've ever tried Valium, which may be less addicting (whatever that means) than Klonopin. You might have to taper down from the Klonopin, so maybe you should wait until your regular returns.
It would have helped if you had said how much Wellbutrin you were taking, but Wellbutrin, along with increasing amounts of Valium, starting at 2 to 5 mg., every 2 hours up to 20 or 30 mg. per day might control the shakes, yet still allow you the other effects of Wellbutrin. Have you had any withdrawal symptoms when cutting down on the Klonopin? The shakes could be a withdrawal symptom of Klonopin, rather that an effect of Wellbutrin. You also don't mention the effects of Neurontin. Check your PDR (I hope you have one). I think there's a lot of room to increase the neurontin, at least to 1200 mg/day to see if you notice the effect. If there's a possibility of you getting pregnant, you should check for possible fetal effects from the benzodiazepines.
BTW, does your rumination have anything to do with this good looking, blushable Therapist going on vacation? Do you know if he's married? You said that you felt ok a few days ago, but you also say that after a week on 2 mg. of Klonopin your "back to being a nervous wreck. Did you increase it or decrease it to 2 mg.? When did your Therapist leave for vacation?
Posted by JohnL on July 21, 2001, at 3:50:59
In reply to What do I do now?, posted by Else on July 20, 2001, at 14:19:08
> Right now I am freaking out a little bit because I'm turning into a nervous wreck again. I have a very high tolerance for sedatives and after a week on 2mg Klonopin daily I am back to being a nervous wreck. It should be noted that I also take 900mg Neurontin in addition to this. Now I used to feel OK a few days ago (and not drowsy at all mind you) but now I'm getting all worked up over nothing again. I recently (two weeks ago) stopped taking Wellbutrin because I didn't think it was helping at all and because it gave me those annoying tremors but now I am not so sure it was a good idea. When my doc asked what dose of Klonopin I though would be O.K. I said 2mg even though I really though three would be better (didn't want to look like one of 'em drug addicts, you know). Anyway. Now my doc is on vacation and I have to work next week and I am bouncing off the walls. Is this due to depression rearing it's ugly head because I dropped the Wellbutrin ( I'm ruminating but not really depressed at this point)? Should I go back on the Wellbutrin? Increase the Klonopin to 3mg like I though would be best from the beginning? What?
>
> And while I'm at it. This is a question for all of you anxious/dysthymic people out there. What have you found works best. Years ago I was on a combo of Prozac and Xanax for 6 weeks but it's kind of blurry now. Are there other drugs that would have the same effect as Wellbutrin (non-serotoninergic, very important), without the tremors? Any ideas? Suggestions? I don't know what to do anymore. I don't want depression and I certainly don't want anxiety (nor anticholinergic effects and the like...) Am I asking to much?
>
> I've tried:
>
> Prozac (20mg die), Xanax (0.25mg tid), Zoloft (100mg die), Depakote (500mg tid), Effexor (300mg die), Wellbutrin (150mg bid) Neurontin (300mg tid) and now Klonopin (0.5 bid + 1.0 HS). I found that anti-convulsants were useless, that drugs that enhanced my mood made me more anxious (Effexor & Wellbutrin)and that drug that made me less anxious made me more depressed (tranquilizers). So now what. Please somebody help.Hi,
One word, Zyprexa. I have yet to see any single drug with as much promise as this one. Just because it is named as an antipsychotic, don't let that scare you. It has been shown in clinical studies to be effective for a wide variety of psychiatric symptoms. Personally I have seen more people get well with antipsychotics and/or stimulants than antidepressants, mood stabilizers, etc. In my own experience, and it's just my opinion, not fact (what in psychiatry is fact anyway?) Zypexa blows the ADs in the weeds. It works on dopamine, norepinephrine, and serotonin, all three, and has an anti-anxiety component to it. Mileage of course varies, but in this hit and miss game I believe Zyprexa offers better odds for success than just about any other choice I can think of.Sedation is heavy at first. Don't worry, it goes away, and the good sleep might be a welcome relief anyway. Weight gain is often a problem, but can be avoided by drinking a large glass of water before meals, and by being careful with snacks. Best overall results when combined with Prozac.
John
Posted by Else on July 21, 2001, at 5:39:43
In reply to Re: What do I do now?, posted by SalArmy4me on July 21, 2001, at 1:38:53
Is this related to Trazodone? If so I want nothing to do with it. I don't do well on serotonergic agents. They usually don't help at all and make me jitterry. I'd prefer something that acts on DA and/or NE or GABA,anything really, but not that. It really screws me up. Besides I would think doctors would be wary about prescribing nefadozone these days in Canada since Health Canada has just figured out that in rare cases it can cause irreversable liver damage.(Something doctors already know since it's in the Canadian version of the PDR, but still, it might discourage them). But thank you anyways.
> Have you tried nefazodone? http://www.vh.org/Providers/Conferences/CPS/16.html
Posted by Else on July 21, 2001, at 6:59:45
In reply to Re: What do I do now?, posted by JohnL on July 21, 2001, at 3:50:59
Well I don't know. It does work on serotonine does it not? I do terribly on drugs like Zoloft and Effexor, they make me shake and twich like crazy. And I'm very sensitive to the sedative effects of anti-histamines. Too sensitive. One girl here once told me Zyprexa felt like a anti-histamine and that's not encouraging. I would lean toward stimulants more than APs. Especially considering the possible weight gain on Zyprexa. I know a lot of people here swear by it but I am really put off by anti-psychotics because my brother turned into a complete weirdo on Risperdal (which he was taking for anxiety and temper tantrums). He just became Zombie-like. I don't know anyone who takes Zyprexa but I would be wary about it for that very reason.
>Personally I have seen more people get well with antipsychotics and/or stimulants than antidepressants, mood stabilizers, etc.
Which stimulants are you reffering to?
Thanks for the suggestions> Hi,
> One word, Zyprexa. I have yet to see any single drug with as much promise as this one. Just because it is named as an antipsychotic, don't let that scare you. It has been shown in clinical studies to be effective for a wide . get well with antipsychotics and/or stimulants . Personally I have seen more people get well with antipsychotics and/or stimulants than antidepressants, mood stabilizers, etc.han antidepressants, mood stabilizers, etc.variety of psychiatric symptoms In my own experience, and it's just my opinion, not fact (what in psychiatry is fact anyway?) Zypexa blows the ADs in the weeds. It works on dopamine, norepinephrine, and serotonin, all three, and has an anti-anxiety component to it. Mileage of course varies, but in this hit and miss game I believe Zyprexa offers better odds for success than just about any other choice I can think of.
>
> Sedation is heavy at first. Don't worry, it goes away, and the good sleep might be a welcome relief anyway. Weight gain is often a problem, but can be avoided by drinking a large glass of water before meals, and by being careful with snacks. Best overall results when combined with Prozac.
> John
Posted by Else on July 21, 2001, at 7:37:05
In reply to Re: What do I do now? » Else, posted by jojo on July 21, 2001, at 3:10:11
>
> I don't see that you've ever tried Valium, which may be less addicting (whatever that means) than Klonopin. You might have to taper down from the Klonopin, so maybe you should wait until your regular returns.I have tried Valium but have not obtained it through legal means (ahem, I ordered it from yugoslavia). I think it's very effective but I'm not sure it's better than Klonopin. Addiction is not a concern for me, I survived lorazepam withdrawal, I can survive anything.
> It would have helped if you had said how much Wellbutrin you were taking, but Wellbutrin, along with increasing amounts of Valium, starting at 2 to 5 mg., every 2 hours up to 20 or 30 mg. per day might control the shakes, yet still allow you the other effects of Wellbutrin.
I used to take 300mg every day, now I only take 150 ( I read in the CPS which is the Canadian PDR that doses above 150mg have not proven to be more effective and it also says that on the box). Is Klonopin as effective as Valium in controlling tremors? It is an anticonvulsant but I don't know if this has anything to do with it. Typically, I need large doses of benzos so 30mg Valium sounds about right.
>Have you had any withdrawal symptoms when cutting down on the Klonopin? The shakes could be a withdrawal symptom of Klonopin, rather that an effect of Wellbutrin. You also don't mention the effects of Neurontin. Check your PDR (I hope you have one). I think there's a lot of room to increase the neurontin, at least to 1200 mg/day to see if you notice the effect. If there's a possibility of you getting pregnant, you should check for possible fetal effects from the benzodiazepines.
No, Wellbutrin makes me shake even more when I don't take Klonopin. One GP said it was an Extra-Pyramidal symptom which I find less than reassuring. I've never had withdrawal symptoms from Klonopin but when I came off Ativan I didn't shake, I just felt this electrical buzzing throughout my body (I also felt like I weighed a million pounds and that my death was imminent, this was not a gradual taper, mmind you, 6mg to nothing the next day. Some quack at the hospital was responsible for this fuck-up). Neurontin can cause shaking but I have not had that side effect while I was taking it on its own. Neurontin doesn't do anything but lower anxiety slightly and cause sexual side effects as far as I can tell.
> BTW, does your rumination have anything to do with this good looking, blushable Therapist going on vacation? Do you know if he's married? You said that you felt ok a few days ago, but you also say that after a week on 2 mg. of Klonopin your "back to being a nervous wreck. Did you increase it or decrease it to 2 mg.? When did your Therapist leave for vacation?
NO, it started before I found out the tragic news. My ruminations have to do with imagining the worst that could possibly happen in every situation I might face the following day, as usual. I started out using 2mg and stayed at that.
There was no change in dosage. I suppose my doctor must have left right after I saw him which was on the 13th. I didn't ask when he was coming back. I probably should have. I'll call his secretary on monday. I've given this some thought. I think it's safe to increase the Klonopin to 3mg and drop the Neurontin. Right now I'm going back on Wellbutrin (only 150mg, no shakes) to improve my mood. I think I'll wait until I see my doctor to change the Klonopin dosage since otherwise, I'll run out before it's "time" and the drugstore wont want to refill my prescription. The remaining problem is Neurontin. I hate it but maybe it does help stabilizing my mood (it's the impression that I get, I stopped for a few days and I was very irritable and cried for no reason, but then maybe that's just PMS). Which make me realise: I don't get PMS on Wellbutrin. I'll have to double check but I think it's true. This is the first time I get PMS symptoms in months and I just stopped Wellbutrin. Anyway. I hope it's only a one week vacation. Lovely weather. He's probably married. I looked him up in the phone book, he lives in the suburbs (I'm not a stalker or anything, I was just curious, ok). I always forget to check for rings and more obvious signs. He has these hypnotic pale blue eyes , you see, very distracting.
Posted by JohnL on July 21, 2001, at 9:31:24
In reply to Re: What do I do now? » JohnL, posted by Else on July 21, 2001, at 6:59:45
Yeah, it does have some effect on increasing serotonin activity, but in a totally different way than SSRIs. While SSRIs hold existing serotonin in place and let it build up by accumulation, Zyprexa instead stimulates the release of fresh new serotonin. I like that a lot better.
Zyprexa does have anti-histimine effects, and I too am sensitive to that. But after a week most of that subsides. And after a month it's nearly gone completely.
Stimulants I was referring to are Ritalin, Adderall, or my favorite, Adrafinil (European mailorder). Adrafinil is a kinder gentler stimulant that increases norepinephrine activity without increasing norepinephrine levels, and it also has some indirect effects on stimulating dopamine D2 receptors. Unlike the other stimulants which you can feel almost immediatley, Adrafinil takes days to weeks to come on.
> Well I don't know. It does work on serotonine does it not? I do terribly on drugs like Zoloft and Effexor, they make me shake and twich like crazy. And I'm very sensitive to the sedative effects of anti-histamines. Too sensitive. One girl here once told me Zyprexa felt like a anti-histamine and that's not encouraging. I would lean toward stimulants more than APs. Especially considering the possible weight gain on Zyprexa. I know a lot of people here swear by it but I am really put off by anti-psychotics because my brother turned into a complete weirdo on Risperdal (which he was taking for anxiety and temper tantrums). He just became Zombie-like. I don't know anyone who takes Zyprexa but I would be wary about it for that very reason.
>
> >Personally I have seen more people get well with antipsychotics and/or stimulants than antidepressants, mood stabilizers, etc.
>
> Which stimulants are you reffering to?
>
>
> Thanks for the suggestions
>
> > Hi,
> > One word, Zyprexa. I have yet to see any single drug with as much promise as this one. Just because it is named as an antipsychotic, don't let that scare you. It has been shown in clinical studies to be effective for a wide . get well with antipsychotics and/or stimulants . Personally I have seen more people get well with antipsychotics and/or stimulants than antidepressants, mood stabilizers, etc.han antidepressants, mood stabilizers, etc.variety of psychiatric symptoms In my own experience, and it's just my opinion, not fact (what in psychiatry is fact anyway?) Zypexa blows the ADs in the weeds. It works on dopamine, norepinephrine, and serotonin, all three, and has an anti-anxiety component to it. Mileage of course varies, but in this hit and miss game I believe Zyprexa offers better odds for success than just about any other choice I can think of.
> >
> > Sedation is heavy at first. Don't worry, it goes away, and the good sleep might be a welcome relief anyway. Weight gain is often a problem, but can be avoided by drinking a large glass of water before meals, and by being careful with snacks. Best overall results when combined with Prozac.
> > John
Posted by Sherry on July 21, 2001, at 15:10:45
In reply to Re: What do I do now?, posted by JohnL on July 21, 2001, at 9:31:24
Hey JohnL,
If SSRIs hold existing serotonin in place, how do MAOIs work? Do they stimulate the release as well as inhibit MAO to prevent breakdown? What about Effexor and Serzone? I suffer from atypical depression, but I feel my body and brain are far too dependent on carbs for emotional well being. I can actually feel my insulin levels fluctuate throughout the day. So, my thinking is I need something that stimulates the release of serotonin. Most of the reuptake inhibitors make me dumb as dirt.
I hope you are doing well.Sherry
> Yeah, it does have some effect on increasing serotonin activity, but in a totally different way than SSRIs. While SSRIs hold existing serotonin in place and let it build up by accumulation, Zyprexa instead stimulates the release of fresh new serotonin. I like that a lot better.
>
> Zyprexa does have anti-histimine effects, and I too am sensitive to that. But after a week most of that subsides. And after a month it's nearly gone completely.
>
> Stimulants I was referring to are Ritalin, Adderall, or my favorite, Adrafinil (European mailorder). Adrafinil is a kinder gentler stimulant that increases norepinephrine activity without increasing norepinephrine levels, and it also has some indirect effects on stimulating dopamine D2 receptors. Unlike the other stimulants which you can feel almost immediatley, Adrafinil takes days to weeks to come on.
>
> > Well I don't know. It does work on serotonine does it not? I do terribly on drugs like Zoloft and Effexor, they make me shake and twich like crazy. And I'm very sensitive to the sedative effects of anti-histamines. Too sensitive. One girl here once told me Zyprexa felt like a anti-histamine and that's not encouraging. I would lean toward stimulants more than APs. Especially considering the possible weight gain on Zyprexa. I know a lot of people here swear by it but I am really put off by anti-psychotics because my brother turned into a complete weirdo on Risperdal (which he was taking for anxiety and temper tantrums). He just became Zombie-like. I don't know anyone who takes Zyprexa but I would be wary about it for that very reason.
> >
> > >Personally I have seen more people get well with antipsychotics and/or stimulants than antidepressants, mood stabilizers, etc.
> >
> > Which stimulants are you reffering to?
> >
> >
> > Thanks for the suggestions
> >
> > > Hi,
> > > One word, Zyprexa. I have yet to see any single drug with as much promise as this one. Just because it is named as an antipsychotic, don't let that scare you. It has been shown in clinical studies to be effective for a wide . get well with antipsychotics and/or stimulants . Personally I have seen more people get well with antipsychotics and/or stimulants than antidepressants, mood stabilizers, etc.han antidepressants, mood stabilizers, etc.variety of psychiatric symptoms In my own experience, and it's just my opinion, not fact (what in psychiatry is fact anyway?) Zypexa blows the ADs in the weeds. It works on dopamine, norepinephrine, and serotonin, all three, and has an anti-anxiety component to it. Mileage of course varies, but in this hit and miss game I believe Zyprexa offers better odds for success than just about any other choice I can think of.
> > >
> > > Sedation is heavy at first. Don't worry, it goes away, and the good sleep might be a welcome relief anyway. Weight gain is often a problem, but can be avoided by drinking a large glass of water before meals, and by being careful with snacks. Best overall results when combined with Prozac.
> > > John
Posted by JohnL on July 21, 2001, at 19:11:44
In reply to Re: What do I do now? » JohnL, posted by Sherry on July 21, 2001, at 15:10:45
> Hey JohnL,
>
> If SSRIs hold existing serotonin in place, how do MAOIs work? Do they stimulate the release as well as inhibit MAO to prevent breakdown? What about Effexor and Serzone? I suffer from atypical depression, but I feel my body and brain are far too dependent on carbs for emotional well being. I can actually feel my insulin levels fluctuate throughout the day. So, my thinking is I need something that stimulates the release of serotonin. Most of the reuptake inhibitors make me dumb as dirt.
> I hope you are doing well.
>
> SherryHi Sherry,
MAOIs are similar to SSRIs in the respect that they allow accumulation of existing serotonin, as well as NE and dopamine too. They do not stimulate the release. MAOIs prevent the natural breakdown process of neurotransmitters.Effexor is primarily an SSRI, but it also has some reuptake inhibition of norepinephrine, and at higher doses some reuptake inhibition of dopamine. Effexor does not stimulate release.
Serzone is an SSRI, plus a slight norepinephrine reuptake inhibitor, and it also stimulates serotonin a little. The thing I do not like about Serzone is that it also blocks alpha receptors, which in itself can make people depressed. In the last couple years I've seen a pattern here at this board of people who actually got worse on Serzone. Including me. Some people like it though. Strangely, one of the meds in my successful cocktail is Adrafinil, which does the opposite of Serzone. That is, it helps the alpha receptors instead of blocking them. I think mine were blocked to begin with, and maybe that was a problem all along. Adrafinil unblocked it.
But I have also come to realize in my own trials that what looks good on paper, and what looks good in theory, isn't that much help. It can help to steer you in the right direction, for example in choosing which category of meds to try (i.e. SSRIs, antipsychotics, stimulants, etc). But the only way to find out for sure is a real life trial of the drug. I wish there was a better way.And yes, I am doing well. Finally. 1990 to 2000 was pure hell. 2001 is looking great. Thank goodness for Prozac, Zyprexa, and Adrafinil. Sometimes I still like to do a dose of Amisulpride now and then, simply because it feels like a mile stimulant and gives me an extra boost if I need it.
I hope YOU are doing well today.
John
Posted by Else on July 21, 2001, at 20:01:47
In reply to Re: What do I do now? » JohnL, posted by Sherry on July 21, 2001, at 15:10:45
Have you tried Ecstacy? (Half-joking)
> Hey JohnL,
>
> If SSRIs hold existing serotonin in place, how do MAOIs work? Do they stimulate the release as well as inhibit MAO to prevent breakdown? What about Effexor and Serzone? I suffer from atypical depression, but I feel my body and brain are far too dependent on carbs for emotional well being. I can actually feel my insulin levels fluctuate throughout the day. So, my thinking is I need something that stimulates the release of serotonin. Most of the reuptake inhibitors make me dumb as dirt.
> I hope you are doing well.
>
> Sherry
>
> > Yeah, it does have some effect on increasing serotonin activity, but in a totally different way than SSRIs. While SSRIs hold existing serotonin in place and let it build up by accumulation, Zyprexa instead stimulates the release of fresh new serotonin. I like that a lot better.
> >
> > Zyprexa does have anti-histimine effects, and I too am sensitive to that. But after a week most of that subsides. And after a month it's nearly gone completely.
> >
> > Stimulants I was referring to are Ritalin, Adderall, or my favorite, Adrafinil (European mailorder). Adrafinil is a kinder gentler stimulant that increases norepinephrine activity without increasing norepinephrine levels, and it also has some indirect effects on stimulating dopamine D2 receptors. Unlike the other stimulants which you can feel almost immediatley, Adrafinil takes days to weeks to come on.
> >
> > > Well I don't know. It does work on serotonine does it not? I do terribly on drugs like Zoloft and Effexor, they make me shake and twich like crazy. And I'm very sensitive to the sedative effects of anti-histamines. Too sensitive. One girl here once told me Zyprexa felt like a anti-histamine and that's not encouraging. I would lean toward stimulants more than APs. Especially considering the possible weight gain on Zyprexa. I know a lot of people here swear by it but I am really put off by anti-psychotics because my brother turned into a complete weirdo on Risperdal (which he was taking for anxiety and temper tantrums). He just became Zombie-like. I don't know anyone who takes Zyprexa but I would be wary about it for that very reason.
> > >
> > > >Personally I have seen more people get well with antipsychotics and/or stimulants than antidepressants, mood stabilizers, etc.
> > >
> > > Which stimulants are you reffering to?
> > >
> > >
> > > Thanks for the suggestions
> > >
> > > > Hi,
> > > > One word, Zyprexa. I have yet to see any single drug with as much promise as this one. Just because it is named as an antipsychotic, don't let that scare you. It has been shown in clinical studies to be effective for a wide . get well with antipsychotics and/or stimulants . Personally I have seen more people get well with antipsychotics and/or stimulants than antidepressants, mood stabilizers, etc.han antidepressants, mood stabilizers, etc.variety of psychiatric symptoms In my own experience, and it's just my opinion, not fact (what in psychiatry is fact anyway?) Zypexa blows the ADs in the weeds. It works on dopamine, norepinephrine, and serotonin, all three, and has an anti-anxiety component to it. Mileage of course varies, but in this hit and miss game I believe Zyprexa offers better odds for success than just about any other choice I can think of.
> > > >
> > > > Sedation is heavy at first. Don't worry, it goes away, and the good sleep might be a welcome relief anyway. Weight gain is often a problem, but can be avoided by drinking a large glass of water before meals, and by being careful with snacks. Best overall results when combined with Prozac.
> > > > John
Posted by SalArmy4me on July 22, 2001, at 0:27:53
In reply to Re: What do I do now?, posted by Else on July 21, 2001, at 20:01:47
Serzone's AD action is probably not linked to its ability to create serotonin reuptake inhibition:
http://www.preskorn.com/cgi-bin/sp.pl?words=nefazodone&wt=be&bl=an&d=/books/omd_s8.html
"Nefazodone likely only produces serotonin (5-HT)-2A inhibition at doses £ 300 mg/day and even at doses of 500 mg/day does not appear to produce the same degree of the serotonin reuptake inhibition as occurs with the SSRIs and venlafaxine at their starting doses.150 This pharmacology is consistent with the clinical advantages and disadvantages of nefazodone..."
"All of the above factors cause an apparently greater degree of interpatient variability in terms of response to nefazodone than is true for many of the other new antidepressants. Nevertheless, nefazodone can be a useful antidepressant option for the primary-care practitioner for selected patients such as those who do not tolerate the adverse effects caused by serotonin reuptake inhibition..."
Posted by Else on July 22, 2001, at 8:43:01
In reply to Serzone » Else, posted by SalArmy4me on July 22, 2001, at 0:27:53
Then what does it do? At this point, I'm pretty convinced I need an AD that act on NE or DA (or both) or a stimulant. I can't take Effexor, the serotoninergic effect is too strong and Wellbutrin make me twitch. At this point, I'm pretty sure a stimulant/benzo combo would do the trick but I'm trying to work up the nerve to ask my doctor for this. I think Canada is stricter on the use of stimulants for something other than narcolepsy and childhood ADHD than the US is but that might have more to do with doctor's beliefs than with the law. I'll look up Serzone but if it's in any way like Desyrel I am not taking it. It's the worst drug I ever took.
Thanks Sal
> Serzone's AD action is probably not linked to its ability to create serotonin reuptake inhibition:
>
> http://www.preskorn.com/cgi-bin/sp.pl?words=nefazodone&wt=be&bl=an&d=/books/omd_s8.html
>
> "Nefazodone likely only produces serotonin (5-HT)-2A inhibition at doses £ 300 mg/day and even at doses of 500 mg/day does not appear to produce the same degree of the serotonin reuptake inhibition as occurs with the SSRIs and venlafaxine at their starting doses.150 This pharmacology is consistent with the clinical advantages and disadvantages of nefazodone..."
>
> "All of the above factors cause an apparently greater degree of interpatient variability in terms of response to nefazodone than is true for many of the other new antidepressants. Nevertheless, nefazodone can be a useful antidepressant option for the primary-care practitioner for selected patients such as those who do not tolerate the adverse effects caused by serotonin reuptake inhibition..."
Posted by Sherry on July 22, 2001, at 11:55:44
In reply to Re: What do I do now? Sherry, posted by JohnL on July 21, 2001, at 19:11:44
JohnL,
Thanks for the lesson. Your knowledge is valuable to this board. I'm one of those people that likes an explanation for why things happen. I know, I know, sometimes there just isn't one, but it drives me nuts until I at least form a theory. I just don't understand why I can't take SSRIs or Effexor or Serzone. I may never know but I'll keep researching none the less.
I'm getting ready to do a trial of Nardil. Please keep your fingers crossed for me.
I'm so happy you're doing well. You deserve it. Ten years is a long time to suffer. Hang in there, and have a great day.
Sherry
> > Hey JohnL,
> >
> > If SSRIs hold existing serotonin in place, how do MAOIs work? Do they stimulate the release as well as inhibit MAO to prevent breakdown? What about Effexor and Serzone? I suffer from atypical depression, but I feel my body and brain are far too dependent on carbs for emotional well being. I can actually feel my insulin levels fluctuate throughout the day. So, my thinking is I need something that stimulates the release of serotonin. Most of the reuptake inhibitors make me dumb as dirt.
> > I hope you are doing well.
> >
> > Sherry
>
> Hi Sherry,
> MAOIs are similar to SSRIs in the respect that they allow accumulation of existing serotonin, as well as NE and dopamine too. They do not stimulate the release. MAOIs prevent the natural breakdown process of neurotransmitters.
>
> Effexor is primarily an SSRI, but it also has some reuptake inhibition of norepinephrine, and at higher doses some reuptake inhibition of dopamine. Effexor does not stimulate release.
>
> Serzone is an SSRI, plus a slight norepinephrine reuptake inhibitor, and it also stimulates serotonin a little. The thing I do not like about Serzone is that it also blocks alpha receptors, which in itself can make people depressed. In the last couple years I've seen a pattern here at this board of people who actually got worse on Serzone. Including me. Some people like it though. Strangely, one of the meds in my successful cocktail is Adrafinil, which does the opposite of Serzone. That is, it helps the alpha receptors instead of blocking them. I think mine were blocked to begin with, and maybe that was a problem all along. Adrafinil unblocked it.
>
> But I have also come to realize in my own trials that what looks good on paper, and what looks good in theory, isn't that much help. It can help to steer you in the right direction, for example in choosing which category of meds to try (i.e. SSRIs, antipsychotics, stimulants, etc). But the only way to find out for sure is a real life trial of the drug. I wish there was a better way.
>
> And yes, I am doing well. Finally. 1990 to 2000 was pure hell. 2001 is looking great. Thank goodness for Prozac, Zyprexa, and Adrafinil. Sometimes I still like to do a dose of Amisulpride now and then, simply because it feels like a mile stimulant and gives me an extra boost if I need it.
>
> I hope YOU are doing well today.
> John
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.