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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Bob on August 27, 2009, at 11:45:23
SLS:
What med regimen are you currently on, if you don't mind me asking. I'm just curious, really.
I'm currently on 50mg of Nortriptyline, 10mg of Citalopram, and 0.5mg of Mirapex spread throughout the day in 4 doses of 0.125mg.
I'm starting to experience some apathy, and more disconcertingly, sleep attacks in the late afternoon. For awhile the Mirapex seemed to stave off the apathy but I think I've reached that point of saturation I always seem to get stuck on. I'm reticent to go up on the Mirapex as I don't really see how that wouldn't just make the sleepiness worse and intensify any type of withdrawal I might later run into.
Bob
Posted by Phillipa on August 27, 2009, at 11:54:02
In reply to Question for SLS (or anyone else who cares), posted by Bob on August 27, 2009, at 11:45:23
Bob quite a few of SLS's posts list his current meds. Hope he sees this. Phillipa
Posted by SLS on August 27, 2009, at 13:22:53
In reply to Question for SLS (or anyone else who cares), posted by Bob on August 27, 2009, at 11:45:23
Hi Bob.
> What med regimen are you currently on, if you don't mind me asking. I'm just curious, really.
I'm currently taking:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
lithium 600mgAll of the dosages have been tweaked to optimize the combination with the exception of lithium. I am still working on finding the minimum effective dosage for lithium.
> I'm currently on 50mg of Nortriptyline, 10mg of Citalopram, and 0.5mg of Mirapex spread throughout the day in 4 doses of 0.125mg.
50mg of nortriptyline is usually a bit too low. Most people need 75mg or higher. As a guide, you can have your blood tested for a drug level.
I'm sure you know that 10mg of citalopram is too low for the average person. 40mg seems to be about right for most people with severe depression.
Is the apathy part of your depression, or is it a side effect of the citalopram?
I agree with you that it might not be worth increasing the dosage of Mirapex. Although the sleep attacks may not get worse, I don't have very much confidence in the drug to be of benefit for more than a few days to a few months. I really haven't heard of any horror stories associated with the discontinuation of Mirapex. Maybe the withdrawal symptoms won't be that bad.
Which of the following drugs have been helpful?
- Parnate, Nardil, Marplan
- Effexor, Cymbalta, Pristiq
- Lexapro
- Zoloft
- Prozac
- Abilify, Geodon, Seroquel, Zyprexa
- Wellbutrin
If you are looking for a boost in dopamine, after you are done investigating nortriptyline, you could try Abilify + Wellbutrin + Lamictal. If you can tolerate it, you could also add either Effexor, Zoloft, or Lexapro. If you wish to try an MAOI like Parnate, you would have to discontinue the citalopram.For right now, I guess I would discontinue the Mirapex, titrate the dosage of citalopram to 40mg, and raise the dosage of nortriptyline to 75mg and get a blood level after a week.
If you have any family members with depression, what drugs have been helpful for them? First degree relatives have a tendency to respond to the same drugs.
- Scott
Posted by Bob on August 27, 2009, at 13:23:37
In reply to Re: Question for SLS (or anyone else who cares) » Bob, posted by Phillipa on August 27, 2009, at 11:54:02
> Bob quite a few of SLS's posts list his current meds. Hope he sees this. Phillipa
Yeah, I figured. Hopefully he can give me a link or something, as I didn't find it when I searched just now. I'll look again.
Posted by SLS on August 27, 2009, at 13:31:08
In reply to Re: Question for SLS (or anyone else who cares), posted by SLS on August 27, 2009, at 13:22:53
I just wanted to mention that there are many treatment alternatives available for you to try, so don't give up if some of these things don't work out.
I will be curious to see what other ideas people contribute. However, the more information you can provide, the more relevant will be the suggestions.
- Scott
Posted by Bob on August 27, 2009, at 21:19:45
In reply to Re: Question for SLS (or anyone else who cares), posted by SLS on August 27, 2009, at 13:22:53
> Hi Bob.
>
> > What med regimen are you currently on, if you don't mind me asking. I'm just curious, really.
>
> I'm currently taking:
>
> Parnate 80mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mg
> lithium 600mg
>
> All of the dosages have been tweaked to optimize the combination with the exception of lithium. I am still working on finding the minimum effective dosage for lithium.That is a very robust combo. I don't think I could tolerate even one of those drugs at the doses you are taking.
>
> > I'm currently on 50mg of Nortriptyline, 10mg of Citalopram, and 0.5mg of Mirapex spread throughout the day in 4 doses of 0.125mg.
>
> 50mg of nortriptyline is usually a bit too low. Most people need 75mg or higher. As a guide, you can have your blood tested for a drug level.
>
> I'm sure you know that 10mg of citalopram is too low for the average person. 40mg seems to be about right for most people with severe depression.
Yeah, I'm aware of the low doses I take, but I have about 15 years of bad responses to AD's under my belt, so I'm laying low for now and have enrolled in a study for an investigational treatment. For now, I'm now allowed to adjust my meds per the protocol. Hopefully by next month though I will be able to.
>
> Is the apathy part of your depression, or is it a side effect of the citalopram?
The apathy is a side effect of citalopram as well as many other psych drugs - all the SSRI's except maybe Prozac (which caused panic) as well as mood stabilizers such as Depakote and Lithium. A few other things that happen with these drugs are: extreme hot flashes, extreme fatigue and sleepiness, total loss of goal directed behavior or any sort of motivation. There are way, way to many problems to list here, with each med having its own uniquely tailored hell.
>
> I agree with you that it might not be worth increasing the dosage of Mirapex. Although the sleep attacks may not get worse, I don't have very much confidence in the drug to be of benefit for more than a few days to a few months. I really haven't heard of any horror stories associated with the discontinuation of Mirapex. Maybe the withdrawal symptoms won't be that bad.
>
> Which of the following drugs have been helpful?
>
> - Parnate, Nardil, Marplan
> - Effexor, Cymbalta, Pristiq
> - Lexapro
> - Zoloft
> - Prozac
> - Abilify, Geodon, Seroquel, Zyprexa
> - Wellbutrin
>I haven't really tried MAOI's because I'm so sick I don't think I'd survive the washout periods - especially if it was a failed trial. Of the remaining drugs you listed Effexor, Welbutrin, and Abilify showed a temporary response. This was years ago and they all collapsed into serious non-response with very problematic side effects eventually. For example, I was eventually sleeping about 15 hours per day on Effexor and most of my waking time was spent stuffing my face. In the first months of treatment, however, I actually got a good response. That was the last truly good response I ever got from a med and that was about 12 years ago. Welbutrin and Abilify were somewhat energizing but eventually became intolerable from a physical standpoint as well as not providing a decent response any longer.
>
> If you are looking for a boost in dopamine, after you are done investigating nortriptyline, you could try Abilify + Wellbutrin + Lamictal. If you can tolerate it, you could also add either Effexor, Zoloft, or Lexapro. If you wish to try an MAOI like Parnate, you would have to discontinue the citalopram.Why do you not have an SSRI in your regimen? My problem with serotonergic drugs is massive weight gain (aside from the lethargy and somnolence).
>
>
>
> For right now, I guess I would discontinue the Mirapex, titrate the dosage of citalopram to 40mg, and raise the dosage of nortriptyline to 75mg and get a blood level after a week.
>
> If you have any family members with depression, what drugs have been helpful for them? First degree relatives have a tendency to respond to the same drugs.My family members (mother and sister) both respond much, much better to SSRI's and SNRI's than I do, but they are not without their problems. My sister is on Pristiq right now and has ballooned up significantly in weight. My parents have said it is painful to see what the drug has done to her physically, and I know from first hand experience what they mean.
>
>
> - Scott
Posted by Zyprexa on August 28, 2009, at 3:39:19
In reply to Question for SLS (or anyone else who cares), posted by Bob on August 27, 2009, at 11:45:23
I'm on Zyprexa 10, perphenazine 12x3, sertraline 150, bupropion sr 300, cogentin 1.
I've been very sick for the last many years, probably 6. With all the med changes and trials, which were probably unnecessary. Finaly I'm back to what works again (10mg zyprexa) and a few other changes. I've been out of work for 2 years and now back in college. Hopfully I will get a good job soon. The sad thing is all this could have been avoided if I just stuck to the 10mg zyprexa, which had worked perfectly for the previous 7 years. Why did I have to take geodon, abilify, lamictal and others that just made me worse? Well I complained about the weight gain and sedation that I was getting from the zyprexa. What a huge mistake.
Zyprexa
Posted by SLS on August 28, 2009, at 5:09:09
In reply to Re: Question for SLS (or anyone else who cares) » SLS, posted by Bob on August 27, 2009, at 21:19:45
Hi Bob.
You have a very frustrating case. I admire your perseverance.
Do you know what treatment you will be given in the study?
I can't take a serotonin reuptake inhibitor because of its potential to precipitate serotonin syndrome when combined with Parnate. Lithium is somewhat serotonergic, but through different mechanisms.
- Scott
Posted by Bob on August 30, 2009, at 23:56:22
In reply to Re: Question for SLS (or anyone else who cares), posted by SLS on August 28, 2009, at 5:09:09
> Hi Bob.
>
> You have a very frustrating case. I admire your perseverance.
>
> Do you know what treatment you will be given in the study?
>
> I can't take a serotonin reuptake inhibitor because of its potential to precipitate serotonin syndrome when combined with Parnate. Lithium is somewhat serotonergic, but through different mechanisms.
>
>
> - ScottHow foolish of me! Here I was thinking that you just didn't respond well - or couldn't tolerate -
SSRI's, but you're taking an MAOI!I know exactly what treatment I'm getting or will be getting but am reluctant to discuss it at the moment since it's still in the beginning placebo stages. Hopefully in the not-too-distant future I can elaborate further.
Thank you for admiring my perserverance, but as I've said before, many if not almost all on this board perservere, and few as well as you.
Bob
Posted by SLS on August 31, 2009, at 3:50:04
In reply to Re: Question for SLS (or anyone else who cares) » SLS, posted by Bob on August 30, 2009, at 23:56:22
> > Do you know what treatment you will be given in the study?
> I know exactly what treatment I'm getting or will be getting but am reluctant to discuss it at the moment since it's still in the beginning placebo stages. Hopefully in the not-too-distant future I can elaborate further.
2-week placebo run-in?
I understand your reticence in saying too much at this point. I hope you achieve your objective.
Thanks for the complement.
:-)
- Scott
This is the end of the thread.
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