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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Anna Laura on March 3, 2002, at 15:24:50
I think i need an "expert" here.
Here's my situation briefly: i'm on Effexor since the end of July of the last year.
I started tapering it in december as i was going to switch to Parnate. Unfortunately the pure compound wasn't available in my country, the parnate version here being a mix of tranycylpromine and an antypsychotic called modaline. I found out about that (my pdoc didn't tell me) when i was about to drop the last dose of effexor.
Since i can't tolerate antypsichotics, (they make me more depressed) i went back to effexor and raised the dose again back to 300 mg. (I'm on Reboxetine too: 8 mg).
I was badly disappointed as it didn't seem to work again this time. Felt kind of scared and more depressed and went back to my old negative thoughts.
After two months i noticed a slight mood improvement i hadn't experienced before. Strangely it worked different this time: anhedonia and mood improved more then the first time but i lost my increased motivation, positive thinking and drive along the way. It's like i can't have all of those things together.
I lost my mental focus and i feel kind of insecure also. Something similar happened years ago when i dropped Tofranil: i had recovered from major depression, my mood had improved but my drive and motivation had decreased.
What does that mean? I've read somewhere noradrenaline is involved in drive, motivation and self esteem whereas serotonin affects mood. Since i'm taking effexor at high doses and Reboxetine, which is a noradrenergic drug, should be the other way around. Seems like the noradrenergic effect has vanished.
I'm rather puzzled right now. Any clues?
Posted by paulb on March 3, 2002, at 18:30:01
In reply to Need advice:combo works differently 2nd time aroun, posted by Anna Laura on March 3, 2002, at 15:24:50
Hi Anna Laura,
I know you have been here for a while and I feel I know a little bit about you. You live in Italy and you have severe anhedonia. Im sorry to hear your medicine isnt helping. Your post was very medication focused. Has you ever tried augmenting the medication with psychotherapy.In regard to medication, I cant see the rationale for using Effexor and Reboxetine since Effexor will enhance norepinephrine. Your right though, anhedonia would be a condition associated more with norepinephrine and/or dopamine and therefore Effexor may not be a good choice because it increases serotonin as well. Reboxetine alone is a possibility however it hasnt made much of a bang, being as it is the first SNRI and from what I can gather over here in the UK not many are on it. Its metabolised by the Cytochrome P450 system the same as Paroxetine which is basically Reboxetine's twin, only it enhances Serotonin-potently, selectively and cleanly. The difference is that Paroxetine is prescribed in 20-60mg tabs/liquid formulation and Reboxetine in 4mg-12mg?. Studies have shown over and over again that at 10mg Paroxetine doesnt do much. Perhaps this is true of Reboxetine. Its a shame but all is not lost, far from it......
I can forsee three possibilities for you:
Wellbutrin-Blockade of norepinephrine re-uptake
Desipramine-Blockade of norepinephrine re-uptake
Maprotiline-Even more so than Desipramine, a re-uptaketer of norepinephrineAugment with T3. Much evidence is available for this augmentation stategy and I have reason to believe that it is a better augmentor with the norepinephrine antidepressants than others.
If you got one of the TCA's I mentioned and T3 and still had problems you could consider an anticonvulsant such as Lamotrigine.
This is just a viewpoint and not recommendation, rather something I would look into if I was you.
In the past you mentioned L-Dopa. You are obviously aware of the importance of the catecholamines role in drive and energy. As I suggested back then why not try L-Tyrosine. Did you? Did you have any luck?
PaulB
Posted by Anna Laura on March 4, 2002, at 0:10:37
In reply to Re: Need advice:combo works differently 2nd time aroun, posted by paulb on March 3, 2002, at 18:30:01
> Hi Anna Laura,
> I know you have been here for a while and I feel I know a little bit about you. You live in Italy and you have severe anhedonia. Im sorry to hear your medicine isnt helping. Your post was very medication focused. Has you ever tried augmenting the medication with psychotherapy.
>
> In regard to medication, I cant see the rationale for using Effexor and Reboxetine since Effexor will enhance norepinephrine. Your right though, anhedonia would be a condition associated more with norepinephrine and/or dopamine and therefore Effexor may not be a good choice because it increases serotonin as well. Reboxetine alone is a possibility however it hasnt made much of a bang, being as it is the first SNRI and from what I can gather over here in the UK not many are on it. Its metabolised by the Cytochrome P450 system the same as Paroxetine which is basically Reboxetine's twin, only it enhances Serotonin-potently, selectively and cleanly. The difference is that Paroxetine is prescribed in 20-60mg tabs/liquid formulation and Reboxetine in 4mg-12mg?. Studies have shown over and over again that at 10mg Paroxetine doesnt do much. Perhaps this is true of Reboxetine. Its a shame but all is not lost, far from it......
>
> I can forsee three possibilities for you:
>
> Wellbutrin-Blockade of norepinephrine re-uptake
> Desipramine-Blockade of norepinephrine re-uptake
> Maprotiline-Even more so than Desipramine, a re-uptaketer of norepinephrine
>
> Augment with T3. Much evidence is available for this augmentation stategy and I have reason to believe that it is a better augmentor with the norepinephrine antidepressants than others.
>
> If you got one of the TCA's I mentioned and T3 and still had problems you could consider an anticonvulsant such as Lamotrigine.
>
> This is just a viewpoint and not recommendation, rather something I would look into if I was you.
>
> In the past you mentioned L-Dopa. You are obviously aware of the importance of the catecholamines role in drive and energy. As I suggested back then why not try L-Tyrosine. Did you? Did you have any luck?
> PaulB
Hi PaulFirst of all, a mention about psychotherapy: i've been there, done that. Many times. Doesn't do much, as i believe my depression was triggered by severe stress and abuse. I've always been quite aware of my emotional difficulties and managed to resolve them at last but didn't help as i believe it's a chemical related problem now. I've been suffering from severe psychotic depression endogenous type (wasn't affected from positive events at all).
I managed to get out of that hole but i've been suffering from anhedonia ever since.
My anhedonia actually got worse throughout the years, that's why i'm getting so pessimistic right now.
I was more "active" and had more energy and drive when i was depressed: major anxiety but far more lively. It's like i've got more negative symptoms now (Frontal syndrome? Am i degenerating? Probably. I believe my brain is dead. Don't want to live like that).I did CBT (Cognitive Behavioural Therapy) but again, it didn't help much. I guess it works for people who had disfunctional cognitive patterns before depression and got depressed because of that.
I was quite optimistic and happy person before depression and was very well adapted and successful (especially under the social profile). I did a lot of different psychoterapies as well without success.
I'm getting quite pessimistic at this point cause i seem to get the same lousy response with TCA (Tofranil, Amytryptiline) and SSRI (Zoloft, Prozac and now Effexor).
With TCA it's even worse as they make my mood flat as hell : don't feel bad but don't feel good either as i turn in to a couch potato, Don't want to see anybody, no drive, no energy: very very distant form the flamboyant person i used to be. I used to be a leader.
I think i 'm a little bit better with Effexor as i feel less medicated and more "natural" (still far from being cured though).
I guess you're right : Reboxetine isn't doing much probably and i need higher effexor doses to get a full adrenergic effect. I believe to be a "high-dose" individual as i used to drink huge amounts of alchol when i was a teen-ager, i was the heaviest drinker of my school and i managed to stay on my own two feet when most of the people i knew were knocked out on the same amounts.
I'm gonna get Zyban (Wellbutrin) tomorrow.
Do i have to lower Effexor with Wellbutrin?
T3 augmenting wouldn't be a bad idea as i turned out to have low T 3.
Don't want to mess with mood stabilizers though cause i'm afraid i'll turn in to a vegetable (i'm in a semi-vegetative state already).Thanks for answering
Anna Laura
Posted by JohnX2 on March 4, 2002, at 1:28:56
In reply to Re: Need advice:combo works differently 2nd time a, posted by Anna Laura on March 4, 2002, at 0:10:37
Hi Anna Laura,Good luck with the Wellbutrin.
Of the mood stabilizers, Lamictal has one of
the best anti-depressant profiles and won't turn
you into a vegetable. Few people complain of
emotional blunting. On average it is more stimulating.
You need a good doctor to help you dose it correctly.Topamax is supposed to be good for people who
went through traumatic times, but it can cause
a little brain fog.Best Wishes,
John
> > Hi Anna Laura,
> > I know you have been here for a while and I feel I know a little bit about you. You live in Italy and you have severe anhedonia. Im sorry to hear your medicine isnt helping. Your post was very medication focused. Has you ever tried augmenting the medication with psychotherapy.
> >
> > In regard to medication, I cant see the rationale for using Effexor and Reboxetine since Effexor will enhance norepinephrine. Your right though, anhedonia would be a condition associated more with norepinephrine and/or dopamine and therefore Effexor may not be a good choice because it increases serotonin as well. Reboxetine alone is a possibility however it hasnt made much of a bang, being as it is the first SNRI and from what I can gather over here in the UK not many are on it. Its metabolised by the Cytochrome P450 system the same as Paroxetine which is basically Reboxetine's twin, only it enhances Serotonin-potently, selectively and cleanly. The difference is that Paroxetine is prescribed in 20-60mg tabs/liquid formulation and Reboxetine in 4mg-12mg?. Studies have shown over and over again that at 10mg Paroxetine doesnt do much. Perhaps this is true of Reboxetine. Its a shame but all is not lost, far from it......
> >
> > I can forsee three possibilities for you:
> >
> > Wellbutrin-Blockade of norepinephrine re-uptake
> > Desipramine-Blockade of norepinephrine re-uptake
> > Maprotiline-Even more so than Desipramine, a re-uptaketer of norepinephrine
> >
> > Augment with T3. Much evidence is available for this augmentation stategy and I have reason to believe that it is a better augmentor with the norepinephrine antidepressants than others.
> >
> > If you got one of the TCA's I mentioned and T3 and still had problems you could consider an anticonvulsant such as Lamotrigine.
> >
> > This is just a viewpoint and not recommendation, rather something I would look into if I was you.
> >
> > In the past you mentioned L-Dopa. You are obviously aware of the importance of the catecholamines role in drive and energy. As I suggested back then why not try L-Tyrosine. Did you? Did you have any luck?
> > PaulB
>
>
> Hi Paul
>
> First of all, a mention about psychotherapy: i've been there, done that. Many times. Doesn't do much, as i believe my depression was triggered by severe stress and abuse. I've always been quite aware of my emotional difficulties and managed to resolve them at last but didn't help as i believe it's a chemical related problem now. I've been suffering from severe psychotic depression endogenous type (wasn't affected from positive events at all).
> I managed to get out of that hole but i've been suffering from anhedonia ever since.
> My anhedonia actually got worse throughout the years, that's why i'm getting so pessimistic right now.
> I was more "active" and had more energy and drive when i was depressed: major anxiety but far more lively. It's like i've got more negative symptoms now (Frontal syndrome? Am i degenerating? Probably. I believe my brain is dead. Don't want to live like that).
>
> I did CBT (Cognitive Behavioural Therapy) but again, it didn't help much. I guess it works for people who had disfunctional cognitive patterns before depression and got depressed because of that.
> I was quite optimistic and happy person before depression and was very well adapted and successful (especially under the social profile). I did a lot of different psychoterapies as well without success.
> I'm getting quite pessimistic at this point cause i seem to get the same lousy response with TCA (Tofranil, Amytryptiline) and SSRI (Zoloft, Prozac and now Effexor).
> With TCA it's even worse as they make my mood flat as hell : don't feel bad but don't feel good either as i turn in to a couch potato, Don't want to see anybody, no drive, no energy: very very distant form the flamboyant person i used to be. I used to be a leader.
> I think i 'm a little bit better with Effexor as i feel less medicated and more "natural" (still far from being cured though).
> I guess you're right : Reboxetine isn't doing much probably and i need higher effexor doses to get a full adrenergic effect. I believe to be a "high-dose" individual as i used to drink huge amounts of alchol when i was a teen-ager, i was the heaviest drinker of my school and i managed to stay on my own two feet when most of the people i knew were knocked out on the same amounts.
> I'm gonna get Zyban (Wellbutrin) tomorrow.
> Do i have to lower Effexor with Wellbutrin?
> T3 augmenting wouldn't be a bad idea as i turned out to have low T 3.
> Don't want to mess with mood stabilizers though cause i'm afraid i'll turn in to a vegetable (i'm in a semi-vegetative state already).
>
> Thanks for answering
>
> Anna Laura
Posted by Denise528 on March 4, 2002, at 7:59:15
In reply to Re: Need advice:combo works differently 2nd time aroun, posted by paulb on March 3, 2002, at 18:30:01
Hello Paulb,
I've seen you knocking around going back quite some time. The only reason I spotted your notes was that you seemed to have the same problem as myself in that a drug that once worked no longer does anything (I sympathise totally with Anna Laura too) anyway I was wondering if you had hit on the right drug yet or are you still looking? I'm feeling a bit pessimistic, a sign of my condition I guess, and was looking for a happy ending story, can you oblige?
Denise
Posted by paulb on March 4, 2002, at 16:55:33
In reply to Re: Paulb, have you found anything that works yet?, posted by Denise528 on March 4, 2002, at 7:59:15
I have had some success with the SSRI's. I currently take Sertraline. Im sure Effexor XR would make me "normal" but there are other issues at hand. Part of me doesnt want to get better???and also Ive been like this for so long I grown accustomed to living a certain way.
PaulB
Posted by Denise528 on March 6, 2002, at 12:41:44
In reply to Re: Paulb, have you found anything that works yet?, posted by paulb on March 4, 2002, at 16:55:33
Paul,
I'm sorry that you've not found the answer, I was really hoping that you would have done. Am I right in thinking that you are the person who was originally on Paxil which initially worked and now doestn't? Also, have you thought about trying ECT?
Denise
Posted by paulb on March 6, 2002, at 13:44:12
In reply to Re: Paulb, have you found anything that works yet?, posted by Denise528 on March 6, 2002, at 12:41:44
Im okay. I take Sertraline and now Xanax. The Sertraline is okay the Xanax is terrific although I need the Sertraline for depression. Xanax doesnt help with that. I think Sertraline is a great antidepressant. With the antidepressants and benzodiazepines its been a long trial and error process and for the time-being Im happy with the combination. But like I said part of me doesnt want to get better. Why on earth??????
Well look at the long list of artists who had depression and then Bill Gates, Patric Moore who are Aspergers.
Although it can be extrmely difficult to live with any mental illness, besides medications, beyond psychotherapy, and after a long time you learn your own coping mechanisms. At some point I think you have to ask yourself well why was I born with this illness.Denise, I havent communicated with you before. If you want tell me a little bit about yourself I would like to know more about you.
paulb
Posted by Jill K. on March 6, 2002, at 18:41:15
In reply to Need advice:combo works differently 2nd time aroun, posted by Anna Laura on March 3, 2002, at 15:24:50
> I'm rather puzzled right now. Any clues?
Maybe your experiencing the "poop out" syndrome. What about adding a small dose of a stimulant or provigil? With 8 mg of reboxitine, I am not sure if more norepinephrine from wellbutrin will help.
The other possiblity I think of when I hear an individual loses response to several meds is that of bipolar disorder. The poster "Geezer" went through this and after 20 or so years discovered he/she was actually bipolar. So maybe lamictal would be a good choise. But I doubt this is the case in your situation .... probable just poop out.
Hang in there. Hope your better soon.
Jill
Posted by Anna Laura on March 7, 2002, at 2:13:43
In reply to Poop Out Versus Bipolar » Anna Laura, posted by Jill K. on March 6, 2002, at 18:41:15
> > I'm rather puzzled right now. Any clues?
>
> Maybe your experiencing the "poop out" syndrome. What about adding a small dose of a stimulant or provigil? With 8 mg of reboxitine, I am not sure if more norepinephrine from wellbutrin will help.
>
> The other possiblity I think of when I hear an individual loses response to several meds is that of bipolar disorder. The poster "Geezer" went through this and after 20 or so years discovered he/she was actually bipolar. So maybe lamictal would be a good choise. But I doubt this is the case in your situation .... probable just poop out.
>
> Hang in there. Hope your better soon.
>
> Jill
I was diagnosed as bipolar II a couple of weeks ago. I don't know if the dx is right though: the only thing i know is that i used to get such a temporary relief/depression breakthrough without meds: this short lived healing experience seems to fade away wih time no matter what. I don't know if this is typical of bipolars.
By the way i was told not to try Wellbutrin as i might get manic. I wasn't at ease with the pdoc who has diagnosed me as bipolar II as he labelled me borderline also. He doesn't know a thing about me and this guy is giving me labels after half an hour interview! Can't believe this. He noticed i was angry + told him about my past history of abuse and thought "she must be borderline".
I'm supposed to call a psichopharmacologist woman i felt comfortable with tomororrow: i'll stick to Effexor and see what she's going to tell me. Did Geezer feel good with mood stabilizers? I'm going to look for her posts on the archive.Thanks for the info!
blessing
Anna Laura
Posted by Jill K. on March 7, 2002, at 23:42:58
In reply to Re: Poop Out Versus Bipolar, posted by Anna Laura on March 7, 2002, at 2:13:43
> I was diagnosed as bipolar II a couple of weeks ago. I don't know if the dx is right though: the only thing i know is that i used to get such a temporary relief/depression breakthrough without meds: this short lived healing experience seems to fade away wih time no matter what. I don't know if this is typical of bipolars.
> By the way i was told not to try Wellbutrin as i might get manic. I wasn't at ease with the pdoc who has diagnosed me as bipolar II as he labelled me borderline also. He doesn't know a thing about me and this guy is giving me labels after half an hour interview! Can't believe this. He noticed i was angry + told him about my past history of abuse and thought "she must be borderline".
> I'm supposed to call a psichopharmacologist woman i felt comfortable with tomororrow: i'll stick to Effexor and see what she's going to tell me. Did Geezer feel good with mood stabilizers? I'm going to look for her posts on the archive.
>
> Thanks for the info!
>
> blessing
>
> Anna LauraHey,
I think bipolar II is overdiagnosed. Although this maybe a good thing, a trial of mood stablizers can't hurt, but missing a bipolar diagnoses will.
I still think the previous poster is experiencing poop out, not bipolar.
J
Posted by JohnX2 on March 8, 2002, at 0:49:14
In reply to Re: Poop Out Versus Bipolar, posted by Jill K. on March 7, 2002, at 23:42:58
If you purely ignore "labels" that these flowchart
doctors try to stick on us and look at people's
histories with medicines and how they affect
the brain/body and poop out (for example BarbaraCat),
membrane stabilizers (I'll call them by their
chemical property instead of psychological label
- mood stabilizer) do indeed statistically
improve the odds of maintaining a robust
and predictable antidepressant response for
many people.Best Regards,
John>
> > I was diagnosed as bipolar II a couple of weeks ago. I don't know if the dx is right though: the only thing i know is that i used to get such a temporary relief/depression breakthrough without meds: this short lived healing experience seems to fade away wih time no matter what. I don't know if this is typical of bipolars.
> > By the way i was told not to try Wellbutrin as i might get manic. I wasn't at ease with the pdoc who has diagnosed me as bipolar II as he labelled me borderline also. He doesn't know a thing about me and this guy is giving me labels after half an hour interview! Can't believe this. He noticed i was angry + told him about my past history of abuse and thought "she must be borderline".
> > I'm supposed to call a psichopharmacologist woman i felt comfortable with tomororrow: i'll stick to Effexor and see what she's going to tell me. Did Geezer feel good with mood stabilizers? I'm going to look for her posts on the archive.
> >
> > Thanks for the info!
> >
> > blessing
> >
> > Anna Laura
>
> Hey,
>
> I think bipolar II is overdiagnosed. Although this maybe a good thing, a trial of mood stablizers can't hurt, but missing a bipolar diagnoses will.
>
> I still think the previous poster is experiencing poop out, not bipolar.
>
> J
Posted by JohnX2 on March 8, 2002, at 0:56:32
In reply to Re: Poop Out Versus Bipolar, posted by JohnX2 on March 8, 2002, at 0:49:14
PS: I find the antidepressants (chemical boosters) make me feel
much more like "somebody else" than the membrane
stabilizers.-John
>
> If you purely ignore "labels" that these flowchart
> doctors try to stick on us and look at people's
> histories with medicines and how they affect
> the brain/body and poop out (for example BarbaraCat),
> membrane stabilizers (I'll call them by their
> chemical property instead of psychological label
> - mood stabilizer) do indeed statistically
> improve the odds of maintaining a robust
> and predictable antidepressant response for
> many people.
>
> Best Regards,
> John
>
>
>
>
>
> >
> > > I was diagnosed as bipolar II a couple of weeks ago. I don't know if the dx is right though: the only thing i know is that i used to get such a temporary relief/depression breakthrough without meds: this short lived healing experience seems to fade away wih time no matter what. I don't know if this is typical of bipolars.
> > > By the way i was told not to try Wellbutrin as i might get manic. I wasn't at ease with the pdoc who has diagnosed me as bipolar II as he labelled me borderline also. He doesn't know a thing about me and this guy is giving me labels after half an hour interview! Can't believe this. He noticed i was angry + told him about my past history of abuse and thought "she must be borderline".
> > > I'm supposed to call a psichopharmacologist woman i felt comfortable with tomororrow: i'll stick to Effexor and see what she's going to tell me. Did Geezer feel good with mood stabilizers? I'm going to look for her posts on the archive.
> > >
> > > Thanks for the info!
> > >
> > > blessing
> > >
> > > Anna Laura
> >
> > Hey,
> >
> > I think bipolar II is overdiagnosed. Although this maybe a good thing, a trial of mood stablizers can't hurt, but missing a bipolar diagnoses will.
> >
> > I still think the previous poster is experiencing poop out, not bipolar.
> >
> > J
Posted by Geezer on March 8, 2002, at 9:53:25
In reply to Poop Out Versus Bipolar » Anna Laura, posted by Jill K. on March 6, 2002, at 18:41:15
> > I'm rather puzzled right now. Any clues?
>
> Maybe your experiencing the "poop out" syndrome. What about adding a small dose of a stimulant or provigil? With 8 mg of reboxitine, I am not sure if more norepinephrine from wellbutrin will help.
>
> The other possiblity I think of when I hear an individual loses response to several meds is that of bipolar disorder. The poster "Geezer" went through this and after 20 or so years discovered he/she was actually bipolar. So maybe lamictal would be a good choise. But I doubt this is the case in your situation .... probable just poop out.
>
> Hang in there. Hope your better soon.
>
> JillGreetings I'm Geezer,
Don't overlook that DX of possible Bipolar II, it cost me big time. I can't see the harm in a trial of a "mood stabilizer". Glad to share experience if you want it.
Posted by Peter S. on March 8, 2002, at 12:25:51
In reply to Re: Poop Out Versus Bipolar, posted by Geezer on March 8, 2002, at 9:53:25
I've never had much success with mood stabilizers. I have had hypo-manic type reactions to anti-depressants- although it is hard to tell the difference between hypo-manic and just feeling "normal" and good. I notice that I do tend to have what might be called "ultradian" cycles- generally I feel lousy in the AM and all day and then my mood lifts around 8:00PM. Someone posted a link to this article: http://www.acnp.org/g4/GN401000110/Default.htm which discusses the successful use of nimodipine in ultra-fast mood changes (ultradian).
Any experiences with Nimodipine or other experiences with ultra rapid cycling?
Thanks
Peter
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
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