![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by ed_uk on December 4, 2022, at 13:16:47
Hi Link,
Did you return to the combination below? I've tried to keep this short.
Given the trouble you've had with venlafaxine, I would personally avoid it.
Is mirtazapine 7.5mg just for sleep?I find quetiapine 25mg effective for sleep and wears off by the morning, unlike many other meds. High doses are unpleasant, for me, especially anything above 50mg. It's surprising how effective 25mg is though!
I wondered whether a suitable treatment for you might be:
Quetiapine 25mg at night
Lithium carbonate 300mg at night
Methylphenidate 5mg twice a day, or 10mg in the morning if preferred.I know your symptoms fluctuate over time, at which point you can adjust if needed.
- venlafaxine 37.5
- mirtazapine 7.5mg
> - lithium 300mg
> - ritalin 10mg
>
> Wellbutin was doing something, but it wasn't nearly as grounding as ritalin.
>
> Linkadge
Posted by linkadge on December 4, 2022, at 15:15:00
In reply to Linkadge medication, posted by ed_uk on December 4, 2022, at 13:16:47
Hi Ed,
Long time, no see.
I have thought about replacing the mirtazapine with something else, but it works very well for sleep. I have dissolved 15mg tabs in a dropper bottle and literally just use drops of it. Even less than 1mg can be sedating. I was considering seroquel or trazodone as alternatives, but not sure if this is needed.
There are times when the effexor can help anxiety. Sometimes I only take it for a few days at a time (literally just counting spheroids within a 37.5mg cap). However, it's a bit less predictable.
Linkadge
Posted by SLS on December 4, 2022, at 15:56:24
In reply to Linkadge medication, posted by ed_uk on December 4, 2022, at 13:16:47
Hi, Ed.
Would you expect your suggestion to enable linkage to achieve remission and resume his career - given a sufficient trial is conducted as established by the medical community?
- Scott
Posted by SLS on December 4, 2022, at 16:34:31
In reply to Re: Linkadge medication, posted by SLS on December 4, 2022, at 15:56:24
> Hi, Ed.
>
> Would you expect your suggestion to enable linkage to achieve remission and resume his career - given a sufficient trial is conducted as established by the medical community?
>
>
> - ScottGiven what you know about Linkadge, wouldn't it be a better bet to guarantee that won't?
What do you know about the oral preparation of zuranolone? I thought it was supposed to be approved in the U.S. by now. How difficult is it to get U.S. drugs not approved in Canada? I was able to get moclobemide and clomipramine from Canada, and reboxetine from England. Zuranolone is one of a series of compounds developed by SAGE that includes brexanolone (ZULRESSO), the I.V. given to women suffering from post-partum depression. The last time I looked, both drugs were described as positive allosteric modulators at the GABA-A receptor. I'm disappointed I haven't heard much about it lately. It is certainly a novel mechanism.
- Scott
Posted by Jay2112 on December 4, 2022, at 22:20:25
In reply to Re: Linkadge medication, posted by linkadge on December 4, 2022, at 15:15:00
> Hi Ed,
>
> Long time, no see.
>
> I have thought about replacing the mirtazapine with something else, but it works very well for sleep. I have dissolved 15mg tabs in a dropper bottle and literally just use drops of it. Even less than 1mg can be sedating. I was considering seroquel or trazodone as alternatives, but not sure if this is needed.
>
> There are times when the effexor can help anxiety. Sometimes I only take it for a few days at a time (literally just counting spheroids within a 37.5mg cap). However, it's a bit less predictable.
>
> LinkadgeHey Link....
A couple of things...I don't know how you see it.
First, get your testosterone levels checked. I was only low by a very small fraction on my lab test. And, what happened to me before is happening again. After 4-5 months of daily "T", I am feeling very good, quite like the stormin' 30 year old guy I used to be. I have my "MOJO" back, I sleep awesome, and I have both more energy to do LOTS of things..and more optimistic .I lost much of my "grumpiness", and I have some new goals and ideas in life. And MY GAWD...sex is INCREDIBLE!!
Don't just take my word for it..just google TRT +
reddit, and you will find many identical stories!!
I don't crave more meds...I am now happy and funny most of the time!!Sorry for going on, but testosterone, when used properly, IS an antidepressant, anti-anxiety, pro social, happiness 'drug'! And it has little in the way of side effects, except me being one happy dude! And it's not an artificial, drug-induced happiness...it's THE real thing, baby! lol.
I am feeling the things I long thought were dead..not just sexual, but an awakening to all of the great things in my life.
You have to be very patient, but you have come this far. Plus psych meds are mostly terrible for deadening the great things in mens lives.
Just a thought...
Jay
p.s. I lost two inches off my weight so far. :)
Posted by ed_uk on December 5, 2022, at 1:23:16
In reply to Re: Linkadge medication, posted by linkadge on December 4, 2022, at 15:15:00
Hmm maybe it's not needed then. If it still works and doesn't persist the next day. Quetiapine was mainly a suggestion because there appears to be less tolerance to the sedative effect, and it wears off quicker. Less pill cutting as well, should be OK just to take a 25mg tablet.
I assume there is less tolerance because low doses of quetiapine block alpha-1 and H1, rather than mostly H1 with very small amounts of mirtazapine.
Posted by ed_uk on December 5, 2022, at 1:28:59
In reply to Re: Linkadge medication, posted by SLS on December 4, 2022, at 15:56:24
Hi Scott,
I don't know about that! Was more a suggestion based on something which might help, and which is often possible to obtain. These meds do appear to have been helpful before, except quetiapine.
Link's symptoms are highly variable over time, as far as I can tell. As a result, I can see it being necessary to make changes in future. The response to antidepressants doesn't seem to have been stable.
Posted by ed_uk on December 5, 2022, at 1:54:11
In reply to Re: Linkadge medication, posted by SLS on December 4, 2022, at 16:34:31
I've not heard anything about zuranolone being approved. It looks like the efficacy isn't sustained after stopping treatment. Unsure that the 14 day treatment is adequate. The difference between active and placebo also narrowed by day 14.
The mechanism of action sounds rather like a benzodiazepine, although binding at the neurosteroid receptors.
Interesting though.
Posted by SLS on December 5, 2022, at 9:07:00
In reply to Re: Linkadge medication » linkadge, posted by Jay2112 on December 4, 2022, at 22:20:25
> > Hi Ed,
> >
> > Long time, no see.
> >
> > I have thought about replacing the mirtazapine with something else, but it works very well for sleep. I have dissolved 15mg tabs in a dropper bottle and literally just use drops of it. Even less than 1mg can be sedating. I was considering seroquel or trazodone as alternatives, but not sure if this is needed.
> >
> > There are times when the effexor can help anxiety. Sometimes I only take it for a few days at a time (literally just counting spheroids within a 37.5mg cap). However, it's a bit less predictable.
> >
> > Linkadge
>
> Hey Link....
>
> A couple of things...I don't know how you see it.
> First, get your testosterone levels checked. I was only low by a very small fraction on my lab test. And, what happened to me before is happening again. After 4-5 months of daily "T", I am feeling very good, quite like the stormin' 30 year old guy I used to be. I have my "MOJO" back, I sleep awesome, and I have both more energy to do LOTS of things..and more optimistic .I lost much of my "grumpiness", and I have some new goals and ideas in life. And MY GAWD...sex is INCREDIBLE!!
> Don't just take my word for it..just google TRT +
> reddit, and you will find many identical stories!!
> I don't crave more meds...I am now happy and funny most of the time!!
>
> Sorry for going on, but testosterone, when used properly, IS an antidepressant, anti-anxiety, pro social, happiness 'drug'! And it has little in the way of side effects, except me being one happy dude! And it's not an artificial, drug-induced happiness...it's THE real thing, baby! lol.
>
> I am feeling the things I long thought were dead..not just sexual, but an awakening to all of the great things in my life.
>
> You have to be very patient, but you have come this far. Plus psych meds are mostly terrible for deadening the great things in mens lives.
>
> Just a thought...
>
> Jay
>
> p.s. I lost two inches off my weight so far. :)That's a great idea, Jay. People I know have said it made a big difference in their sense of well-being. My T level was 227 when I had it checked last. My doctor said that, even though it was within the recommended range, it was definitely too low for her liking. I first need to get the name of a good urologist. That's who takes care of managing T treatment around here.
I have almost no sex drive. This is not an ideal situation for me. I'm not crazy about my testes shutting down, but my GP doctor said that at my age, there is really no need to be concerned about that. I don't like the idea, but I like less not having a sex-drive as I approach my wedding date. Of interest to me is that this didn't occur until I began my current treatment regime 2 years ago. I wonder if adding Nardil caused this unwanted side effect. In the past, this never emerged with Nardil. In fact, Nardil increased my libido significantly in the past. My adding T is a no-brainer. Thanks for suggesting it here.
What forms of administration to you recommend?
Thanks.
- Scott
Posted by SLS on December 5, 2022, at 9:46:32
In reply to Re: Linkadge medication, posted by ed_uk on December 5, 2022, at 1:28:59
> Hi Scott,
>
> I don't know about that! Was more a suggestion based on something which might help, and which is often possible to obtain. These meds do appear to have been helpful before, except quetiapine.
>
> Link's symptoms are highly variable over time, as far as I can tell. As a result, I can see it being necessary to make changes in future. The response to antidepressants doesn't seem to have been stable.I think it would be instructive to read my previous posts to Linkadge. They are scattered on the board, but they are easy to find. Prior to 2 years ago, I was where Linkadge and so many other sufferers are now. There is no way one could have predicted 3 years ago that two antidepressants and two adjuncts that are *commonly* used and are regarded by the medical community as being effective. This is demonstrated to clinicians by years of their own empirical observations of their patients and those related to them by their colleagues.
Sleep? I still have to use Ambien (zolpidem) for sleep a couple of times per week. I think that they are specific rather than selective for the benzodiazepine receptor subtype responsible for exerting hypnotic effects. Although I think Seroquel is wonderfully effective for sleep initiation + maintenane, I sometimes wonder what 25 mg of Seroquel does elsewhere in the brain. Personally, I would rather be on a drug that doesn't produce alterations in the dynamics of dopaminergic pathways. However, Seroquel would be my first choice if Z-drugs were ineffective. My experience with zolpidem is that the only adverse effect of abrupt discontinuation is a moderate rebound insomnia. There were absolutely none of the standard discontinuation side effects that are ubiquitious with standard benzodiazepines. It was strange not to have them.
- Scott
Posted by ed_uk on December 5, 2022, at 12:54:39
In reply to Re: Linkadge medication » ed_uk, posted by SLS on December 5, 2022, at 9:46:32
Hi Scott,
I've seen your posts to Link, and I get your point. I don't know what's available to him, so I made a suggestion based on meds he'd previously found useful, and another med I thought might be useful and may be easy to get prescribed. Not everyone has a doctor willing to give what they ask for. I know I don't!
I don't know whether a bit more quetiapine would be helpful to Link. He could try it, maybe 50mg-100mg.
Personally, I find zolpidem one of the worst drugs I've taken. I only took a few doses. I found it very different to benzos. I went into a disinhibited state a bit like a trance. Then, it caused severe rebound. If I needed a benzo for sleep I'd rather just have diazepam for a few days. I don't get strange side effects, except for odd dreams sometimes.
To be honest, I don't have any issues with quetiapine. I'm extremely (extremely!) sensitive to antipsychotics. And given the experience with others... I don't get the impression that 25mg is doing anything of note to the dopaminergic system. I know how little it takes to give me akathisia and dysphoria, but the dose is so low it is presumably acting as a H1 and alpha-1 antagonist only, as far as I can tell.
Posted by linkadge on December 5, 2022, at 14:13:52
In reply to Re: Linkadge medication » SLS, posted by ed_uk on December 5, 2022, at 12:54:39
I'm still doing well with what I am taking. The lithium + mirtazapine + ritalin seems to be working fairly well.
The ritalin helps me *want* to get better.
Linkadge
Posted by ed_uk on December 5, 2022, at 15:02:23
In reply to Re: Linkadge medication, posted by linkadge on December 5, 2022, at 14:13:52
That sounds positive. Frankly, it does not sound like your experience with antidepressants has been great.
Has your concentration improved? You said you needed shorter messages from SLS a while ago.
Anyway, in terms of antidepressants, have you tried nortriptyline. I believe SLS suggested it, since it's very different from the SSRIs you've struggled with. Plus, it would be a safe add on to your current meds.
Posted by SLS on December 5, 2022, at 17:26:09
In reply to Re: Linkadge medication » SLS, posted by ed_uk on December 5, 2022, at 12:54:39
> Hi Scott,
>
> I've seen your posts to Link, and I get your point. I don't know what's available to him, so I made a suggestion based on meds he'd previously found useful, and another med I thought might be useful and may be easy to get prescribed. Not everyone has a doctor willing to give what they ask for. I know I don't!
>
> I don't know whether a bit more quetiapine would be helpful to Link. He could try it, maybe 50mg-100mg.
>
> Personally, I find zolpidem one of the worst drugs I've taken. I only took a few doses. I found it very different to benzos. I went into a disinhibited state a bit like a trance. Then, it caused severe rebound. If I needed a benzo for sleep I'd rather just have diazepam for a few days. I don't get strange side effects, except for odd dreams sometimes.
>
> To be honest, I don't have any issues with quetiapine. I'm extremely (extremely!) sensitive to antipsychotics. And given the experience with others... I don't get the impression that 25mg is doing anything of note to the dopaminergic system. I know how little it takes to give me akathisia and dysphoria, but the dose is so low it is presumably acting as a H1 and alpha-1 antagonist only, as far as I can tell.
-------
Hi. Ed.Thank you for sharing your observations and insights. I will ask my doctor for quetiapine 25 mg if I need a sleep aid again. I am not at all surprised by your reaction to zolpidem. I found that the best way to take it is to swallow (or sublingual), shut out the lights, and roll into bed. No staying up to watch the news on TV until you become sleepy. By this time. It will be too late, and you are almost assured to experience what you described. Your experience sounds more acute than mine.
Zolpidem reminds me of triazolam (Halcion). How would you compare and contrast the different Z-drugs?
Thank you.
- Scott
Posted by Jay2112 on December 5, 2022, at 17:51:35
In reply to Re: Linkadge medication » Jay2112, posted by SLS on December 5, 2022, at 9:07:00
> > > Hi Ed,
> > >
> > > Long time, no see.
> > >
> > > I have thought about replacing the mirtazapine with something else, but it works very well for sleep. I have dissolved 15mg tabs in a dropper bottle and literally just use drops of it. Even less than 1mg can be sedating. I was considering seroquel or trazodone as alternatives, but not sure if this is needed.
> > >
> > > There are times when the effexor can help anxiety. Sometimes I only take it for a few days at a time (literally just counting spheroids within a 37.5mg cap). However, it's a bit less predictable.
> > >
> > > Linkadge
> >
> > Hey Link....
> >
> > A couple of things...I don't know how you see it.
> > First, get your testosterone levels checked. I was only low by a very small fraction on my lab test. And, what happened to me before is happening again. After 4-5 months of daily "T", I am feeling very good, quite like the stormin' 30 year old guy I used to be. I have my "MOJO" back, I sleep awesome, and I have both more energy to do LOTS of things..and more optimistic .I lost much of my "grumpiness", and I have some new goals and ideas in life. And MY GAWD...sex is INCREDIBLE!!
> > Don't just take my word for it..just google TRT +
> > reddit, and you will find many identical stories!!
> > I don't crave more meds...I am now happy and funny most of the time!!
> >
> > Sorry for going on, but testosterone, when used properly, IS an antidepressant, anti-anxiety, pro social, happiness 'drug'! And it has little in the way of side effects, except me being one happy dude! And it's not an artificial, drug-induced happiness...it's THE real thing, baby! lol.
> >
> > I am feeling the things I long thought were dead..not just sexual, but an awakening to all of the great things in my life.
> >
> > You have to be very patient, but you have come this far. Plus psych meds are mostly terrible for deadening the great things in mens lives.
> >
> > Just a thought...
> >
> > Jay
> >
> > p.s. I lost two inches off my weight so far. :)
>
>
>
> That's a great idea, Jay. People I know have said it made a big difference in their sense of well-being. My T level was 227 when I had it checked last. My doctor said that, even though it was within the recommended range, it was definitely too low for her liking. I first need to get the name of a good urologist. That's who takes care of managing T treatment around here.
>
> I have almost no sex drive. This is not an ideal situation for me. I'm not crazy about my testes shutting down, but my GP doctor said that at my age, there is really no need to be concerned about that. I don't like the idea, but I like less not having a sex-drive as I approach my wedding date. Of interest to me is that this didn't occur until I began my current treatment regime 2 years ago. I wonder if adding Nardil caused this unwanted side effect. In the past, this never emerged with Nardil. In fact, Nardil increased my libido significantly in the past. My adding T is a no-brainer. Thanks for suggesting it here.
>
> What forms of administration to you recommend?
>
> Thanks.
>Hey, thanks Scott. I have to mention that testosterone won't put your sex drive through the roof 24-7 if you are on a serotonin drug. Just, it still is enough to get the engines roaring a bit..lol.
I'd stay away from the needle shots, because it causes some heavy 'up and down' imbalance. The dose goes from a lot, to a little, in the few weeks between your shots. There is a pill form, but I didn't find it quite as effective as the gel form. The two main gels in N. America are Testim and Androgel. Now, Testim is supposed to contain an added chemical that helps with better absorption. But, I find the generic Androgel to be just great! Being generic, it's cheaper too. Testim is applied from a tubed applicator, and it smells pretty nasty too. Androgel (and generic) come in little foil packets, but the gel is a bit watery and such, with little smell of the alcohol, nothing more. You just apply it on an upper arm, or around your belly button.
It's effects are slightly noticed within a few weeks, but it's taken me a number of months before things REALLY got better. You will also find your sleep improves, too. (But, it can cause sleep apnea too, so keep an eye.) I remember the last time I was on it for a long period, the *exact* same feeling I am getting now: contentedness!!! I am relaxed, yet feel physically good to go for a long hike. I remember had stopped my psych meds, and yes, I was good! BUT, I eventually went back on them as I could feel them working, rather than just side effects.
Seriously, I would say it is the BEST antidepressant...no other drug has ever brought this to me. It's also what I call an 'anti-grumppy' drug too, as my patience is extended far beyond what I ever was.
Go on reddit, or drugs.com, and check out the users stories, especially those on it for a long time. Oh, I also noticed my fear and anxiety have come way, way down.
PLEASE, don't hesitate!! As we get older, the testes start to shut/slow down anyways. I had the andropause in my late 30's. My pituitary gland stopped production of both LH and FSH, needed for testosterone production. I was almost at zero!!
Just go on it, stay on it! No, it's not a magic cure all, but seriously, it works wonders. One of the reasons I had my andropause so young was because of the high amounts of estrogen-promoting anti-psychotics and antidepressants. I remember, just before I started the "T" at 38, one day I broke down crying, because not only did I not have any sex drive, but my sex organ was just a useless piece of my body.I should have never have stopped it, and only did so because I lost my job and couldn't afford it. Now, after getting a very low T reading, I said 'enough'..I CAN get that feeling back again! So, I pushed through the few months, and it's all coming back again. Again, if you are on serotonin antidepressants, don't expect to be a pornstar..lol..but morning wood often returns, and sex can once be a fun pursuit again..lol. Since you are getting married Scott, this might be a nice wedding present!
Any further questions...please ask away! :)
Jay
>
> - Scott
Posted by SLS on December 5, 2022, at 22:09:16
In reply to Re: Linkadge medication » SLS, posted by Jay2112 on December 5, 2022, at 17:51:35
Thanks, Jay.
It is generous of you to take the time to help me out. I never placed testosterone on my list of things to try. That was a major oversight on my part.
As the weeks passed while you continued to take testosterone, did the positive effect appear or accelerate all of a sudden, or was it a steady and linear climb?
I know nothing about T therapy. What dosage? How often? 24/7?
You convinced me that I have no reason not to take it. Your recommendation as to how to approach the idea of T-induced testicular atrophy at age 62 is the same as my doctor's. What is the worst case scenario? Keep taking testosterone?
Which of the drugs that I take are capable of reducing testosterone production?1. Nardil - 90 mg/day
* 2. Nortriptyline - 75 mg/day
3. Lamotrigine 300 mg/day
4. Lithium 300 mg/day
I have determined that each drug is absolutely necessary for me to respond to treatment. I performed on/of/on challenges to be sure.
* I recently had to lower the dosage on nortriptyline to maintain an antidepressant response. The therapeutic dosage window has shifted lower since beginning the beginning of treatment. In the beginning, I began to respond at a dosage of 150 mg/day. I can't say for sure that targeting 75 mg/day initially would have worked better, though. I can't tolerate 150 mg/day anymore. I lost my sense of balance equilibrium and fell to the ground several times with no warning - no dizziness. My cognitive state began to slow down and become foggy. A depressive state emerged that felt different from my baseline. I think it could be argued that this was not a true relapse. Now, this cognitive/depressive mood state emerges at 100 mg/day. I began the 75 mg/day dosage two days ago. If I can't recapture a full remission with nortriptyline, I will opt for crossing over to desipramine. I would also consider trimipramine. However, I don't have a clinical "feel" for trimipramine. Do you have any opinions regarding trimipramine?Thanks.
- Scott
Posted by SLS on December 5, 2022, at 23:17:22
In reply to Re: Linkadge medication, posted by linkadge on December 5, 2022, at 14:13:52
> I'm still doing well with what I am taking. The lithium + mirtazapine + ritalin seems to be working fairly well.
>
> The ritalin helps me *want* to get better.
>
> LinkadgeI guess you're on the right track - or at least one of several right tracks.
Can you commit to performing a trial of this combination lasting 6-8 weeks without changing a single thing? Wouldn't this be a novel approach for you compared to most of what you have done over the last 22 years?
Different is different.
I think the following treatment has a better chance of working for Linkadge than what he has chosen as his current trial to treat a depressive disorder. Perhaps the core treatment around which to build an effective treatment can be considered the combination of nortriptyline + lithium. I think that Wellbutrin demonstrated any improvement at all makes it eligible as an adjunct. That's 3 agents that have an established history of treating depression successfully, and are indicated by the FDA for that purpose. Methylphenidate is a stimulant that serves to make you feel better and function better, but is it a true augmenter for you? I don't think so. What is the goal of using an adjunct or augmenter? What is the role that an augmenter plays? Can a drug be labeled an augmenter if it doesn't potentiate the therapeutic effect of the drugs they meant to augment? I don't see how a drug can be an augmenter of a treatment if it doesn't increase the magnitude of the therapeutic response being targeted.
1. Nortriptyline
2. Wellbutrin
3. Lithium4. Methylphenidate
5. Lamotrigine (?)
From what little I know about the pharmacology of these drugs, I thought their mechanisms of action would be more complementary than redundant. Methylphenidate? Why not? It helps Linkadge keep his head above water. Why not take it, even if it has absolutely no capacity to bring about a robust antidepressant response, or complete remission. Anything that helps get someone get through the day that doesn't interfere with the processes being effected by their trials of antidepressants makes sense to me. If an effective palliative treatment allows the affected individual to be able to run a trial to its completion, it is no less essential to achieve the goal than the antidepressants themselves.Beware: I have no letters appended to my last name. It is possible that I am way wrong. Perhaps others can critique my suggestion?
- Scott
Posted by SLS on December 6, 2022, at 8:32:59
In reply to Re: Linkadge medication » SLS, posted by Jay2112 on December 5, 2022, at 17:51:35
Hi again, Jay.
> It is generous of you to take the time to help me out. I never placed testosterone on my list of things to try. That was a major oversight on my part.
I forgot to ask you for a description of your dosage of testosterone and how you arrived at it.
Also, do you use blood levels to determine the optimum dosage?
What was your pre-treatment blood-level of T?
What is your current blood-level of T?
What is your opinion regarding the best values to target?
Does your T therapy cause pimples to appear anywhere on your body?
Lots of questions, I know, but I'm going to follow through with your testosterone suggestion.
Thanks in advance.
- Scott
Posted by Jay2112 on December 6, 2022, at 19:14:19
In reply to Re: Linkadge medication » Jay2112, posted by SLS on December 5, 2022, at 22:09:16
Hi Scott,
.
> Thanks, Jay.
>
> It is generous of you to take the time to help me out. I never placed testosterone on my list of things to try. That was a major oversight on my part.
>NOT a problem at all! I've been given my life back, again (Certainly not "perfect"....the 'usual' challenges are still there, but now I am determined, rather than feeling defeated.) and this is quite different than the feeling gotten from taking a psych med, and going into remission.
It's a more 'natural' feeling....smoother...like water poured onto a drying, dying withering plant
Best described as a feeling of 'resilience'.> As the weeks passed while you continued to take testosterone, did the positive effect appear or accelerate all of a sudden, or was it a steady and linear climb?
>That's a bit of a tough one, because the effects work so subtly in the background. And, it also depends on your individual genetic chemistry. It is believed that the testosterone replacement therapy (TRT) actually switches 'on' genes. It also most certainly affects your monoamine receptors, and all the chemistry in between. For me, it feels like my meds are actually doing their job, and I have even cut back on some of my doses.
There are some mild start-up side effects, and it will take months to REALLY notice the difference, but within a week or two, you will notice some mild changes. The thing is, to not get discouraged, and you WILL be rewarded. I believe I read that is almost a 99.9 percent guarantee. I will try to find some stuff online to elaborate on that. I mentioned that it brings back a quiet confidence. That is a feeling of security, that whatever sh*t happens, you can/will deal with it.> I know nothing about T therapy. What dosage? How often? 24/7?
>I mentioned the different forms..the injection ('shot'), the pill, and the little packets of gel you wipe on your upper arms, and/or abdomen. The gel is alcohol based. It is all standard...everybody gets the same dose. It's apply one packet of gel, 2x a day. The only change that could possibly happen is if your 'T' levels, after months of use, went way sky-high to a dangerous level, but with this standardized dose, they say that is rarely not even possible. If you were using illegal steroids, injecting them twice a day, that is a whole different thing.
> You convinced me that I have no reason not to take it. Your recommendation as to how to approach the idea of T-induced testicular atrophy at age 62 is the same as my doctor's. What is the worst case scenario? Keep taking testosterone?
>Yes, your testes at your age (I don't mean that I am calling you "old") but they probably produce very little T as it is. With TRT, you can actually get back to having a normal amount of T circulating through your body. And, believe me, the mental and bodily effects won't make you 20 or 30 again, but you WILL feel like that SOME of the time!
I was worried about the reports that came out years ago saying going on TRT increases a mans chance of a heart attack and prostate cancer. However, they have done a ton of research on those hypothesis since, and the answer is a resounding "no" to both. The research is widely available on Pubmed, and I have had a look at the sources, and it is not all drug company research. I'd encourage you to check it out, for your own concern, if any.
As well, there is research now saying that correcting T levels in men *reduces* the risk of heart attacks.
> Which of the drugs that I take are capable of reducing testosterone production?
>
> 1. Nardil - 90 mg/day
>
> * 2. Nortriptyline - 75 mg/day
>
> 3. Lamotrigine 300 mg/day
>
> 4. Lithium 300 mg/day
>I'd say the Nardil and Nortriptyline, in particular. The pro-serotogenic drugs, as I found out with Prozac and Effexor, have qualities like being pro-estrogenic, and aromatizing conversion of testosterone to estrogen. These things are an assault on testosterone, and as I said before, caused me to go to andropause in my late 30's. Nortriptyline, lesser so, but it does have some anticholinergic properties that can mess with testosterone. Lamotrigine and lithium, I think much, much less so, but you can investigate on Pubmed. (Not sure how you do your Pubmed searches, but I personally found going to Google, putting in pubmed as my first word, than adding your other keywords brings up maximum results.)
BUT, there is really no need to change your meds. Start with the testosterone, and as I said, you won't exactly be walking around with a banana in your pocket (lol), because you NEED the serotonin acting Nardil. Some days will be better than others...that's just being human, right? One other way I could tell the T was working is that my hot flashes/spells, that I thought were med induced, slowly dissipate. Andropause has a lot of the same symptoms as menopause.
> I have determined that each drug is absolutely necessary for me to respond to treatment. I performed on/of/on challenges to be sure.
>
>
> * I recently had to lower the dosage on nortriptyline to maintain an antidepressant response. The therapeutic dosage window has shifted lower since beginning the beginning of treatment. In the beginning, I began to respond at a dosage of 150 mg/day. I can't say for sure that targeting 75 mg/day initially would have worked better, though. I can't tolerate 150 mg/day anymore. I lost my sense of balance equilibrium and fell to the ground several times with no warning - no dizziness. My cognitive state began to slow down and become foggy. A depressive state emerged that felt different from my baseline. I think it could be argued that this was not a true relapse. Now, this cognitive/depressive mood state emerges at 100 mg/day. I began the 75 mg/day dosage two days ago. If I can't recapture a full remission with nortriptyline, I will opt for crossing over to desipramine. I would also consider trimipramine. However, I don't have a clinical "feel" for trimipramine. Do you have any opinions regarding trimipramine?
>Well, remember, nortriptyline STILL does have some anticholinergic properties, and moreso as you increase the dose. I personally found a good daily choline supplement helped when I was on nortriptyline, and now that I am on amitriptyline.
One med you didn't mention, the tetracyclic maprotiline, I have had the *best* experience for a norepinephrine med. But, it was taken off the market here in Canada. It had a very clean, stimulating feeling, but not as harsh as desipramine.
Trimipramine, I found it just to be really like a very small dose of quetiapine. Very atypical, and lots of dreaming.
So, that's a wrap! You are more than welcome to babblemail me if you wish, and I will try and find more good links with research, stories i.e. personal accounts, and I am excited that you may find something that will add a huge antidepressant/antianxiety...general wellness vigor to your life as you take the marriage plunge. (Sexual health at our age is perfectly attainable these days, and we deserve that joy that comes with it :)
> Thanks.
>
>
> - Scott
>Hope that helps....
Jay :)
>
Posted by SLS on December 7, 2022, at 8:36:22
In reply to Re: Linkadge medication » SLS, posted by Jay2112 on December 6, 2022, at 19:14:19
Jay,
You demonstrate a wealth of ACCURATE and CLINICALLY APPLICABLE information. You have a lot to offer Psycho-Babble. I don't see enough of this here.
I am definitely adding T to my regime. I did not experiencing problems until adding Nardil to nortriptyline. The addition of Nardil coincided with the loss of sex-drive, loss of muscle-mass, and increase in body weight due to an increase in adipose tissue.
I will take you up on your offer to correspond.
Thank you.
Enjoy your hard-earned remission and thank you for describing it to Psycho-Babble.
- Scott
Posted by undopaminergic on December 17, 2022, at 8:22:37
In reply to Re: Linkadge medication » Jay2112, posted by SLS on December 5, 2022, at 22:09:16
> I would also consider trimipramine. However, I don't have a clinical "feel" for trimipramine. Do you have any opinions regarding trimipramine?
>I started trimipramine at 25 mg/day near the end of September 2019. It felt quite promising early on in treatment, and I often felt it was the best medication I've tried that is classified as an antidepressant. Now, I'm at 150 mg/day and it's been a long time, and I'm not really sure it is doing anything any more. The most promising signs came early in treatment, at very low doses. It did not get better with dose increments, but I'm not sure it got worse either.
Pharmacodynamically, I find the most interesting action is histamine H2-receptor antagonism. Another interesting property is that it suppresses cortisol release acutely.
It is a very strong antihistamine (H1-receptor), so it is best taken at night.
-undopaminergic
Posted by SLS on December 17, 2022, at 15:46:57
In reply to Trimipramine » SLS, posted by undopaminergic on December 17, 2022, at 8:22:37
Hi, UD.
> > I would also consider trimipramine. However, I don't have a clinical "feel" for trimipramine. Do you have any opinions regarding trimipramine?
> >
>
> I started trimipramine at 25 mg/day near the end of September 2019. It felt quite promising early on in treatment, and I often felt it was the best medication I've tried that is classified as an antidepressant. Now, I'm at 150 mg/day and it's been a long time, and I'm not really sure it is doing anything any more. The most promising signs came early in treatment, at very low doses. It did not get better with dose increments, but I'm not sure it got worse either.
>
> Pharmacodynamically, I find the most interesting action is histamine H2-receptor antagonism. Another interesting property is that it suppresses cortisol release acutely.
>
> It is a very strong antihistamine (H1-receptor), so it is best taken at night.
>
> -undopaminergic
That's valuable information. Thanks.Trimipramine was the second drug my current doctor tried on me. The first was doxycyline. He wanted to rule-out Lyme Disease. I don't remember if I was taking any other drugs at the time. It didn't make me feel worse, which by itself is a blessing. I don't remember dosages or the length of the trial. It didn't affect me one way or the other.
Do you think trimipramine helps at all by improving sleep architecture? I didn't know that it was so antihistaminergic.
- Scott
Posted by Jay2112 on December 17, 2022, at 17:33:20
In reply to Trimipramine » SLS, posted by undopaminergic on December 17, 2022, at 8:22:37
> > I would also consider trimipramine. However, I don't have a clinical "feel" for trimipramine. Do you have any opinions regarding trimipramine?
> >
>
> I started trimipramine at 25 mg/day near the end of September 2019. It felt quite promising early on in treatment, and I often felt it was the best medication I've tried that is classified as an antidepressant. Now, I'm at 150 mg/day and it's been a long time, and I'm not really sure it is doing anything any more. The most promising signs came early in treatment, at very low doses. It did not get better with dose increments, but I'm not sure it got worse either.
>
> Pharmacodynamically, I find the most interesting action is histamine H2-receptor antagonism. Another interesting property is that it suppresses cortisol release acutely.
>
> It is a very strong antihistamine (H1-receptor), so it is best taken at night.
>
> -undopaminergic
>Sounds similar to doxepin. But that stuff is thr strongest H1 antagonist available, I believe. I have NEVER had such a strong hangover effect as when I tried doxepin.
My late Dad had huge number of allergies, and really responded well to doxepin. He was on 300mg at bedtime, at one point. I DO respond well to anti-histamines, but doxepin, the hangover is just WOW!!
Jay
Posted by Jay2112 on December 17, 2022, at 17:43:22
In reply to Re: Trimipramine » undopaminergic, posted by SLS on December 17, 2022, at 15:46:57
> Hi, UD.
>
> > > I would also consider trimipramine. However, I don't have a clinical "feel" for trimipramine. Do you have any opinions regarding trimipramine?
> > >
> >
> > I started trimipramine at 25 mg/day near the end of September 2019. It felt quite promising early on in treatment, and I often felt it was the best medication I've tried that is classified as an antidepressant. Now, I'm at 150 mg/day and it's been a long time, and I'm not really sure it is doing anything any more. The most promising signs came early in treatment, at very low doses. It did not get better with dose increments, but I'm not sure it got worse either.
> >
> > Pharmacodynamically, I find the most interesting action is histamine H2-receptor antagonism. Another interesting property is that it suppresses cortisol release acutely.
> >
> > It is a very strong antihistamine (H1-receptor), so it is best taken at night.
> >
> > -undopaminergic
>
>
> That's valuable information. Thanks.
>
> Trimipramine was the second drug my current doctor tried on me. The first was doxycyline. He wanted to rule-out Lyme Disease. I don't remember if I was taking any other drugs at the time. It didn't make me feel worse, which by itself is a blessing. I don't remember dosages or the length of the trial. It didn't affect me one way or the other.
>
> Do you think trimipramine helps at all by improving sleep architecture? I didn't know that it was so antihistaminergic.
>
>
> - Scott
>
>Sorry to hijack your post, Scott. But, the sleep architecture thing is interesting. When I first started antidepressants, in the early 90's, it seemed a.d.'s worked best by suppressing my hyper-REM sleep..hyper REM being a strong indicator of depression. However, a few decades later, I started to 'crave' REM sleep. So, mirtazapine seemed to help bring it back. Plus, I lowered my Effexor dose. Effexor is, by far, the greatest REM-killer, in my experience.
I am interested, again, in trimipramine. When I first tried it, it had the antipsychotic pro-REM quality.
Jay
Posted by SLS on December 17, 2022, at 19:40:49
In reply to Re: Trimipramine » undopaminergic, posted by Jay2112 on December 17, 2022, at 17:33:20
Hi, Jay.
> Sounds similar to doxepin. But that stuff is thr strongest H1 antagonist available
You are good.
- Scott
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