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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by JackD on March 6, 2002, at 22:20:19
I've come to realize that the major component to my depression is norepinephrine related through emprical evidence. I have ADD, anxiety, and depression. I am currently on Concerta 18mg a day, Klonopin 1mg a day, and Remeron 30mg a day. I have just restarted Remeron after taking a 2 month break from it. It worked extremely well but then made me even more depressed than I was before taking it. Wellbutrin made me cycle from hypomania to depression, as did Effexor, even at very low doses. I have responded to just about every antidepressant I've tried, and always extremely quickly (especially the NE active ones) and robustly. These include Wellbutrin, Remeron, Effexor, and Paxil.
My questions to the group are: Has anyone taken Clonidine or Tenex and experienced antidepressant action? I figure since NE reuptake inhibitors or antagonists cause strong and often paradoxical reactions, maybe NE agonists may be of some use. Also, why do Norepinephrine acting AD's cause me to cycle so? Am I bipolar? Wellbutrin and Effexor especially are always described as having very low potential in causing cycling in bipolar individuals.
Can anyone shed some light on my strange reactions to meds and NE? Thanks!
Posted by JohnX2 on March 6, 2002, at 22:39:47
In reply to Tenex, Clonidine, Norepinephrine, posted by JackD on March 6, 2002, at 22:20:19
Hi,My thoughts...
Paradoxical reaction? You probably need a mood stabilizer.
I got the same crud. Maybe stealth bipolar II.
Any hypomanic/ADD like symptoms? (You seem to be up on the terminology).
How about Lamictal for starters (good AD action)?
Depakote, Trileptal, Lithium the other standbys.More important than what I think,
what's your doctor thinking about your reactions?-John
> I've come to realize that the major component to my depression is norepinephrine related through emprical evidence. I have ADD, anxiety, and depression. I am currently on Concerta 18mg a day, Klonopin 1mg a day, and Remeron 30mg a day. I have just restarted Remeron after taking a 2 month break from it. It worked extremely well but then made me even more depressed than I was before taking it. Wellbutrin made me cycle from hypomania to depression, as did Effexor, even at very low doses. I have responded to just about every antidepressant I've tried, and always extremely quickly (especially the NE active ones) and robustly. These include Wellbutrin, Remeron, Effexor, and Paxil.
>
> My questions to the group are: Has anyone taken Clonidine or Tenex and experienced antidepressant action? I figure since NE reuptake inhibitors or antagonists cause strong and often paradoxical reactions, maybe NE agonists may be of some use. Also, why do Norepinephrine acting AD's cause me to cycle so? Am I bipolar? Wellbutrin and Effexor especially are always described as having very low potential in causing cycling in bipolar individuals.
>
> Can anyone shed some light on my strange reactions to meds and NE? Thanks!
Posted by JohnX2 on March 6, 2002, at 23:00:09
In reply to Re: Tenex, Clonidine, Norepinephrine » JackD, posted by JohnX2 on March 6, 2002, at 22:39:47
Sorry, I read your post so fast I default assumed
ADD symptoms (damn seen so many bpii stories , same here).Sound like you should be on track if you just add in
a good mood stabilizer like Depakote, Lithium, Tegatrol,
Lamictal. You really should talk to your doc about a
bipolar II dx? A lot of times people kinda waffle over
if the anxiety/ADD symptoms are hypomania related.
Sometimes you can be hypomanic/agitated but not "euphoric"
its called a "mixed" state. Hard to differentiate from anxiety
and ADD symptoms. A lot of times the mood stabilizer will
fix the ADD and anxiety like symptoms by reducing your
agitation. The mood stabilizer often fixes the antidepressant
poop out problems. Also MANY PDOCS including my own prefer
to not even use an antidepressant for bipolar. They feel a mood
stabilizer alone will usually work! Lamictal and lithium have
very good stand alone AD/stabilizer properties.Talk this over with your pdoc.
Best of luck,
John>
> Hi,
>
> My thoughts...
>
> Paradoxical reaction? You probably need a mood stabilizer.
>
> I got the same crud. Maybe stealth bipolar II.
>
> Any hypomanic/ADD like symptoms? (You seem to be up on the terminology).
>
> How about Lamictal for starters (good AD action)?
> Depakote, Trileptal, Lithium the other standbys.
>
> More important than what I think,
> what's your doctor thinking about your reactions?
>
> -John
>
>
> > I've come to realize that the major component to my depression is norepinephrine related through emprical evidence. I have ADD, anxiety, and depression. I am currently on Concerta 18mg a day, Klonopin 1mg a day, and Remeron 30mg a day. I have just restarted Remeron after taking a 2 month break from it. It worked extremely well but then made me even more depressed than I was before taking it. Wellbutrin made me cycle from hypomania to depression, as did Effexor, even at very low doses. I have responded to just about every antidepressant I've tried, and always extremely quickly (especially the NE active ones) and robustly. These include Wellbutrin, Remeron, Effexor, and Paxil.
> >
> > My questions to the group are: Has anyone taken Clonidine or Tenex and experienced antidepressant action? I figure since NE reuptake inhibitors or antagonists cause strong and often paradoxical reactions, maybe NE agonists may be of some use. Also, why do Norepinephrine acting AD's cause me to cycle so? Am I bipolar? Wellbutrin and Effexor especially are always described as having very low potential in causing cycling in bipolar individuals.
> >
> > Can anyone shed some light on my strange reactions to meds and NE? Thanks!
Posted by JackD on March 7, 2002, at 3:16:21
In reply to Re: Tenex, Clonidine, Norepinephrine, posted by JohnX2 on March 6, 2002, at 23:00:09
Thanks John. I am a bit unclear as to what you mean saying it's hard to differentiate between anxiety and ADD symptoms. I have classic non hyperactive ADD, which ritalin works great to fix; I am spacey, easily distractible, and hyperfocused. I know what you mean by mixed states, but usually my hypomanias from NE active antidepressants is quite euphoric (no psychotic reactions whatsoever by the way). What mood stabilizer would you recommend? Which is best for a college student who plans to still drink and maybe smoke pot occasionally?
Posted by JohnX2 on March 7, 2002, at 4:15:33
In reply to Re: Tenex, Clonidine, Norepinephrine, posted by JackD on March 7, 2002, at 3:16:21
I would be really honest with your doctor about
the pot question, they don't care. I don't know
the drug interactions. I'm not a doctor. Take my
advice with a grain of salt.I like Lamictal because it has the fewest side
effects in my opinion. Its less harmful on the liver too,
which is good if you are drinking. Depakote and Lithium
are more harsh on the organs.One caveat about Lamictal is that it is tricky to
dose into. You need a good doctor to do this. You may
want to dig through old posts for strategies (I dont
remember its been so long, i love the med). The main startup
side effect is skin irritation and maybe a little rash and
maybe a little dizziness that subsides.
Just go slowly and if you get itchy slow down. The thereaputic
dose is 150-300 mg. If you are good, you'll get a nice
anti-depressant kick and not need any other anti-depressant.
Otherwise you can work with your doctor on adding Wellbutrin,
Effexor, whatever. I would stay away from an anti-depressant
until you get to a good mood stabilizer dose, because the
AD will just destabilize you.Usually if you really are bipolar its next to impossible to
"lock onto" a anti-depressant response without a
membrane stabilizer in place. It just doesn't work.
I've been there.Depakote is quicker to get onto. It has less of an anti-depressant
profile and may be a bit more coginitive dulling.Lithium is best if you have sever mania problems.
Good LUCK! Have fun in college (but not too much, do some studying
ya know).-John
> Thanks John. I am a bit unclear as to what you mean saying it's hard to differentiate between anxiety and ADD symptoms. I have classic non hyperactive ADD, which ritalin works great to fix; I am spacey, easily distractible, and hyperfocused. I know what you mean by mixed states, but usually my hypomanias from NE active antidepressants is quite euphoric (no psychotic reactions whatsoever by the way). What mood stabilizer would you recommend? Which is best for a college student who plans to still drink and maybe smoke pot occasionally?
Posted by JohnX2 on March 7, 2002, at 4:28:54
In reply to Re: Tenex, Clonidine, Norepinephrine, posted by JohnX2 on March 7, 2002, at 4:15:33
I assume you are saying you are "anxious"
when you are *not* on an anti-depressant?This is where I am saying you may be
really just "agitated", i.e. have a little
bit of extra unnerving energy from being bipolar
(but not on an AD or mood stabilizer )
which makes you seem anxious, but some pdocs
would claim you this IS hypomania WITHOUT feeling
euphoric. See what I mean? They changed the definition
of mania to really just mean agitated, which
could include euphoria, etc. It could also
mean you feel angry, anxious, etc, but not euphoric.A better barometer for the anxiety is whether or
not you are actually psychologically worrying about
something or are you just physically antsy? If it
is just physically antsy and physically nervous with
no euphoria then it is probably what is called "dysphoric hypomania".-John
>
> I would be really honest with your doctor about
> the pot question, they don't care. I don't know
> the drug interactions. I'm not a doctor. Take my
> advice with a grain of salt.
>
> I like Lamictal because it has the fewest side
> effects in my opinion. Its less harmful on the liver too,
> which is good if you are drinking. Depakote and Lithium
> are more harsh on the organs.
>
> One caveat about Lamictal is that it is tricky to
> dose into. You need a good doctor to do this. You may
> want to dig through old posts for strategies (I dont
> remember its been so long, i love the med). The main startup
> side effect is skin irritation and maybe a little rash and
> maybe a little dizziness that subsides.
> Just go slowly and if you get itchy slow down. The thereaputic
> dose is 150-300 mg. If you are good, you'll get a nice
> anti-depressant kick and not need any other anti-depressant.
> Otherwise you can work with your doctor on adding Wellbutrin,
> Effexor, whatever. I would stay away from an anti-depressant
> until you get to a good mood stabilizer dose, because the
> AD will just destabilize you.
>
> Usually if you really are bipolar its next to impossible to
> "lock onto" a anti-depressant response without a
> membrane stabilizer in place. It just doesn't work.
> I've been there.
>
> Depakote is quicker to get onto. It has less of an anti-depressant
> profile and may be a bit more coginitive dulling.
>
> Lithium is best if you have sever mania problems.
>
> Good LUCK! Have fun in college (but not too much, do some studying
> ya know).
>
> -John
>
>
> > Thanks John. I am a bit unclear as to what you mean saying it's hard to differentiate between anxiety and ADD symptoms. I have classic non hyperactive ADD, which ritalin works great to fix; I am spacey, easily distractible, and hyperfocused. I know what you mean by mixed states, but usually my hypomanias from NE active antidepressants is quite euphoric (no psychotic reactions whatsoever by the way). What mood stabilizer would you recommend? Which is best for a college student who plans to still drink and maybe smoke pot occasionally?
Posted by JackD on March 7, 2002, at 13:58:38
In reply to Re: Tenex, Clonidine, Norepinephrine, posted by JohnX2 on March 7, 2002, at 4:28:54
Thanks for all your feedback John. Don't worry about me enjoying college too much; I'm more worried about being capable of fully enjoying it at all. Funny, my pdoc suggested and praised Lamictal as well. I've read in a long ago post that Lamictal has some on action on Serotonin, possibly the 5HT1A receptor site, which could possibly compliment my one true love, Remeron (well, aside from women, cars and beer). I guess I've always known something was awry with my moods, but I've always shied away from the possibility of being manic depressive since it greatly complicates things. Hopefully this could be the start of something really promising...
Posted by TSA West on March 7, 2002, at 15:53:51
In reply to Re: Tenex, Clonidine, Norepinephrine, posted by JackD on March 7, 2002, at 3:16:21
Posted by JohnX2 on March 7, 2002, at 19:21:41
In reply to Re: Tenex, Clonidine, Norepinephrine, posted by JackD on March 7, 2002, at 13:58:38
Hi JackD,It sounds like you have a good pdoc and a good diagnosis.
At this point you should have a good base of meds to go with too.My experience is that with a good doc,diagnosis, and a good base
of medicines to go with its best to just try to move on
with your life as much as possible and let the medicines
do their job (trust them to work). Just like you learn
Mercedes and Harvard have good reputations, don't
need to do much more investigating into the inner workings.Best wishes and good luck,
John> Thanks for all your feedback John. Don't worry about me enjoying college too much; I'm more worried about being capable of fully enjoying it at all. Funny, my pdoc suggested and praised Lamictal as well. I've read in a long ago post that Lamictal has some on action on Serotonin, possibly the 5HT1A receptor site, which could possibly compliment my one true love, Remeron (well, aside from women, cars and beer). I guess I've always known something was awry with my moods, but I've always shied away from the possibility of being manic depressive since it greatly complicates things. Hopefully this could be the start of something really promising...
Posted by JackD on March 9, 2002, at 14:00:28
In reply to Re: Tenex, Clonidine, Norepinephrine » JackD, posted by JohnX2 on March 7, 2002, at 19:21:41
I just begun taking Lithium Carbonate 300 mg capsules twice a day. I am also now taking 30mg of Remeron a day, 18mg of Concerta, and 1mg of Klonopin (Cripes that's a load of meds). I'll let you know how i'm doing in a few weeks.
Posted by JohnX2 on March 9, 2002, at 19:39:32
In reply to Started new treatment, posted by JackD on March 9, 2002, at 14:00:28
Yeah, please keep us posted. I may add a pinch of Li
to my Lamictal. A lot of people are reporting
good success with that strategy. I'm still
fighting a bit of cycling (which isn't bad).
I just have been hearing all these neato lithium
stories and figure I may give it a shot.
A little jealous I can't post my experience..
just about taken everything else!Sounds like a good approach for you being
in the middle of school. A medicine that works
quicker (lithium over lamictal) may be in order.Good luck,
John
> I just begun taking Lithium Carbonate 300 mg capsules twice a day. I am also now taking 30mg of Remeron a day, 18mg of Concerta, and 1mg of Klonopin (Cripes that's a load of meds). I'll let you know how i'm doing in a few weeks.
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