![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by doxogenic boy on August 30, 2009, at 13:12:53
Hello to all of you
When I had used hydromorphone for about two weeks it gave me some bad side effects:
Pain in the heart region, left arm and a feeling of a coming blackout. This led to anxiety each time, but it wasnt panic attacks because I have had that in the past, so I know the difference, but I really feared that the symptoms were physical. Anyway, I had to stop taking hydromorphone due to those side effects.Except of hydromorphone, I use the same medication as I mentioned here:
http://www.dr-bob.org/babble/20090810/msgs/912227.htmlLater in this post I will tell about effects and side effect of some of these meds.
Any answer is welcome. I am particularly interested in other meds to try, both cocktails and monotherapy. My experience to this day, is that every medicine that works, stops working, sooner or later. Are there any of you that have meds that have led to remission and still works after a long time?These are the medication I have tried since 16th of March 1994 until this day:
(not properly chronological)
Trade Name - Generic name
1) Paralgin Forte codeine + paracetamol
2) Seroxat - paroxetine
3) Sobril - oxazepam
4) Trilafon - perphenazine
5) Disipal - orphenadrine
6) Largactil - chlorpromazine
7) Vallergan - alimemazine
8) Akineton - biperiden
9) Flunipam/Rohypnol - flunitrazepam
10) Litarex - lithium citrate
11) Anafranil - clomipramine
12) Tolvon - mianserin
13) Orfiril - sodium valproate
14) Risperdal risperidone
15) Tegretol - carbamazepin
16) Imovane - zopiclone
17) Cipramil - citalopram
18) Stilnoct - zolpidem
19) Nefadar - nefazodone
20) Rivotril - clonazepam
21) Serdolect - sertindole
22) Zyban bupropion
23) Androxon - testosterone undecanoate
24) Parlodel - bromocriptine
25) Atmos testosterone transdermal patch
26) Edronax - reboxetine
27) Noritren - nortriptyline
28) Lamictal - lamotrigine
29) Fontex/Fluoxetin - fluoxetine
30) Primoteston-Depot testosterone enantate for intramuscular injection
31) Efexor - venlafaxine
32) Buspar - buspirone
33) Nardil - phenelzine
34) Stablon - tianeptine
35) Aurorix - moclobemide
36) Modiodal - modafinil
37) Desyrel - trazodone
38) Cipralex - escitalopram
39) Dexedrine - dextroamphetamine
40) Vival - diazepam
41) Temgesic - buprenorphine
42) Nootropil - piracetam
43 Dolcontin/Morfin - morphine
44) Zoloft - sertraline
45) Nozinan - levomepromazine
46) Kloral chloral hydrate
47) Remeron - mirtazapine
48) Surmontil - trimipramine
49) Liothyronin - liothyronine (L-isomer of triiodothyronine (T3))
50) DHEA - dehydroepiandrosterone
51) Xyrem sodium oxybate (gamma-hydroxybutyrate/GHB)
52) Lyrica - pregabalin
53) Seroquel - quetiapine
54) Palladon hydromorphoneSome medicines tried in monotherapy, not a complete list:
Seroxat, Cipramil, Zyban, Noritren, Fontex, Efexor, Nardil, Stablon, Aurorix, Modiodal, Cipralex, Dexedrine, Temgesic, Dolcontin/Morfin, ZoloftSome combinations, not a complete list:
Seroxat + Trilafon
Litarex + Anafranil (1994)
Litarex + Seroxat + Tolvon (1994-95)
Seroxat + Tolvon
Risperdal + Tegretol + Seroxat
Cipramil + Tolvon
Cipramil + Nefadar
Zyban + Parlodel
Noritren + Lamictal
Fluoxetin + Lamictal
Efexor + Buspar
Zoloft + Remeron
Dexedrine + Temgesic
Lyrica + Cipralex + Surmontil + Rivotril + Seroquel + Liothyronin + Stablon
Cipralex + Surmontil + Rivotril + Seroquel + Liothyronin + Stablon
Cipralex + Surmontil + Rivotril + Seroquel + Liothyronin + Stablon + Palladon
+++++++++++++The first week the GP prescribed 10 mg paroxetine a day end March 1994, then 20 mg. After a month I said it didnt work. Then the GP increased the paroxetine from 20 to 60 mg from one day to another; after 14 days or less, was i heaven. I had never been so free from all worries any time of my life. This led to manic psychosis in the period May July/August 1994.
In July that year, I was commited to a mental hospital for the first time in my life. Then, I got the diagnosis bipolar disorder, manic, in partial remission at the end of the hospitalization.
(I have had a lot of diagnoses, the manic depressive pshychosis/bipolar disorder diagnosis was some years later changed to F33 Recurrent depressive disorder (F33.1, F33.2 moderate to severe ICD-10/World Health Organization). In this socalled hospital they gave me perphenazine which caused akatihsia. It is the worst side effect I have ever had.The clomipramine had an acceptable antidepressive effect after the depression that came following chlorpromazine and perphenazine. Lithium was added in Septemer 1994 and I used it to medio March/April 1995. I was happy when I discontinued the lithium, because of the indifference I had. When I got severe anxiety due to a particular obsessional thought in November 1994, clomipramine was replaced with paroxetine and mianserin, this time with another doctor, and the paroxetine dose was gradually upped from 20 to 60 mg 20 th of April 1995. Mianserin was used in doses up to 180 mg, but exept of sedation and weight gain, it had no effect.
From ultimo April 1995 to medio October 1995 I had a good period on 60 mg paroxetine monotherapy, then stopped paroxetine abruptly in October, and two days later I was committed to the same mental hospital with a maniform psychosis.
From 1st of June 1996 to September 1998 I used citalopram in monotheray, with a good effect most of the time, in fact, it is the longest period of a medication that have worked. I used up to 100 mg citalopram.
To not make this an endless post, I will take the rest shorter:
(and this is not the whole story, so you can ask if there are something you wonder of).Generally: SSRIs and venlafaxine worked against depression some time, but all of them pooped out. Phenelzine worsened my depression and I had intense suicidal thoughts. After a month, I couldnt take it anymore, it was too risky. I see that most of you have used, use or plan to use tranylcypromine (Parnate). I have anxiety (and insomnia, but not on the current mix, and it has some antidepressive and anxiolytic effect too, far from good enough, though) as part of the problem, and if I try a medication with anxiety and insomnia as frequent side effect, my experience is that I get anxiety or insomnia, if there arent drugs in the mix that work against those side effects. The first time on paroxetine and citalopram, I had mostly not any anxiety. The last years, the anxiety will come much
My current medication -
-------
quetiapine 600 mg (200 + 100 + 100 + 200 mg)
liothyronine sodium 20 mcg (20 mcg in the morning)
escitalopram 40 mg (40 mg in the morning)
tianeptine 150 mg (4 tablets 12,5 mg three times a day)
clonazepam 1 mg (1 mg at bedtime)
trimipramine 100 mg (100 mg in the evening)
----------
-if I quit escitalopram and take a 14 day washout, will it be dangerous to add tranylcypromine to this combination?Can quetiapine (Seroquel) or some of the other meds I use, stop the anxiety and insomnia tranylcypromine can cause?
I got severe anxiety the first time I tried dextroamphetamine, in combination with a small dose of escitalopram, so I think it is probable that tranylcypromine can do the same.
What other medication can work against anxiety and insomnia when using tranylcypromine?
Nortriptylin is, as far I can rembember amongst the more stimulating or non-sedative of the TCAs, so I suppose it isnt the right drug for this purpose.
I have tried trazodone, but I stopped because of the side effects and it didnt work either.
In a voluntary mental hospital stay in October/November in 2004 I got ECT, but it had just a moderate effect and it destroyed my memory. I had a good memory before, and others have also seen the difference before and after ECT. Now I mostly must rely on notes, search engines and books etc. I didnt consent to the ECT. I have also tried psychodynamic psychotherapy, cognitive behavioral therapy, interpersonal therapy, which is the current therapy with my psychologist one hour weekly, some alternative treatments, jogging and bathing in ice cold whater - the latter the best one.What about isocarboxazid (Marplan), nialamide or iproniazide?
Or an opioid ketobemidone? It has NMDA antagonist properties, which makes it different to buprenorphine and hydromorphone.And since memantine was mentioned, could it give an effect in combination with hydromorphone with a lower dose, so that I dont get those side effect from hydromorphone? Or, can ketobemidone do the same as memantine together with hydromorphone because of the NMDA antagonist properties?
Are there other combinations or meds in monotherapy I can try which I havent tried before, and are there any of you that would like to give the whole list of meds you have tried?
I am empty for any new ideas and I am pretty desperate.doxogenic
Posted by SLS on August 30, 2009, at 13:18:56
In reply to My medication history 1994 to 2009, posted by doxogenic boy on August 30, 2009, at 13:12:53
Can you describe in more detail what are the symptoms of your illness?
How long do you give antidepressants to work before you declare them as a failed trial?
- Scott
Posted by floatingbridge on August 30, 2009, at 13:58:09
In reply to My medication history 1994 to 2009, posted by doxogenic boy on August 30, 2009, at 13:12:53
So no more BP?
I read you older post, too. I am not med savvy--but I care. Hope you get some good brainstorming here. And some relief asap!
fb
Posted by doxogenic boy on August 30, 2009, at 18:56:38
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by SLS on August 30, 2009, at 13:18:56
> Can you describe in more detail what are the symptoms of your illness?
I find it difficult to put it into words, because I am to some extent familiar with using the psychiatric language when I talk to health care professionals, to make it easy to explain.
But I understand the important details will disappear in all those diagnoses.
I worry excessively, and there are several mood swings during the same day.
Most of the day, my life looks hopeless, rest of the day, normally in the evening a few hours or a few moments before I fell asleep, it is better; I am more optimistic and think about what I can do tomorrow or more long time projects. (But not symptom-free, and not hypomanic) If I just could start next morning where I finished the day before, everything had been better; when I wake up, every morning all the plans and thoughts from yesterday seem impossible, useless, stupid, embarrassing if I remember it at all.I have to write down the constructive thoughts from my best moments in my big note book, if not, they are away the next day. Very often, it happens that it is forgotten instantly, so I never reach to write it down. And quite as often, I dont bother to write anything, because of mental blocks that appear in all kind of contexts. For example, I can be reluctant to start my PC, or for cooking in the kitchen; I eat bread and milk and mostly not a dinner Monday to Friday, because it takes too much energy and I have to come through all these mental blocks to be able to starting at all.
The brain is like a search engine that looks for anything dangerous, so that my mind and body are in the alert most of the time or all the time when it is on the worst. All those strenuous thoughts and feelings make me worn out, so there is little or no energy left to do the things I wished I could do, both small matters such as cleaning and tidying up my apartment and bigger things, such as finding meaningful doings to make my life worth living and fighting for.
> How long do you give antidepressants to work before you declare them as a failed trial?About a month but here are big differences.
It will be shorter if it has unbearable side effects or worsen my depression and anxiety and if it makes the situation dangerous.If I can live with the side effects, and/or if it is probable that a worsening of the illness in the beginning is temporary, I can give it several months.
doxogenic
Posted by doxogenic boy on August 30, 2009, at 19:05:33
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by floatingbridge on August 30, 2009, at 13:58:09
> So no more BP?
Buprenorphine? I will maybe give it a try later again with another mix. I also tried to augment the hydromorphone mix (see http://www.dr-bob.org/babble/20090810/msgs/912227.html ) with pregabalin (Lyrica) and buprenorphine respectively, but it didnt do much except of making me drowsy and absent-minded. I suspect the quetiapine (Seroquel) to take away both euphoria, some of the antidepressant effect, and withdrawal from medications like opioids and sodium oxybate (Xyrem). But I need quetiapine both for sleep, and against anxiety and depression.
So my current medication is a trap it gives some relief, but it seems to block the effect of other meds, and I cant risk to stop any of them, because it can worsen my illness significantly, and maybe not work if I try the same combination again.
It took at least 3-4 years of trial and error till I had the current cocktail. Before this, I had given up, I did not believe any medication could work. Still I tried further
> I read you older post, too. I am not med savvy--but I care. Hope you get some good brainstorming here. And some relief asap!Thank you!
It takes a lot of effort to write these posts, but it is rewarding.doxogenic
Posted by floatingbridge on August 30, 2009, at 19:34:34
In reply to Re: My medication history 1994 to 2009 » floatingbridge, posted by doxogenic boy on August 30, 2009, at 19:05:33
> > So no more BP?
No, I meant bipolar. No more part of your dx?
The board is slow today, isn't it? Maybe that's what happens on Sundays....
fb
Posted by doxogenic boy on August 30, 2009, at 21:27:34
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by floatingbridge on August 30, 2009, at 19:34:34
> > > So no more BP?
>
> No, I meant bipolar. No more part of your dx?No.
It has been the F33 Recurrent depressive disorder in ICD-10 for many years now, and some anxiety disorders. And therapy (treatment) resistant depression, also used.> The board is slow today, isn't it? Maybe that's what happens on Sundays....
I am slow, too. Now it is 04:23 Monday 31th of August in the night local time. Maybe I should try sleep deprivation, now when I am at it.
Well, at least I manage to write this night. Earlier this day (or yesterday, Sunday), I didn't think I would get anything done. It is very difficult to look from inside of a depressive mood swing in the morning and afternoon to a possibly better moment at night.
doxogenic
Posted by SLS on August 31, 2009, at 4:38:14
In reply to Re: My medication history 1994 to 2009 » SLS, posted by doxogenic boy on August 30, 2009, at 18:56:38
How did you respond to clomipramine and venlafaxine?
Did you find Prozac helpful at all? 60mg?
- Scott
Posted by doxogenic boy on August 31, 2009, at 5:31:21
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by SLS on August 31, 2009, at 4:38:14
> How did you respond to clomipramine and venlafaxine?
Clomipramine had a good antidepressant effect for about two months, then I got intense anxiety and went back to paroxetine. Venlafaxine worked well in the first months, then it lost effect. I had to use clonazepam for my sleep, venlafaxine was activating.
I also tried venlafaxine + buspirone, but that worsened my sleep problems and it had no sign of effect the time I tried it.> Did you find Prozac helpful at all? 60mg?
Same as the others, the effect was OK some time, and then it stopped working. All these three meds also worked against OCD.
I think I tried 60 or 80 mg, but I have to check my notes to see if I find more details, so this post is with certain reservations. (I have to go for the bus now).
My psychiatrist said today that I could try to add pramipexole to the mix, but I still would appreciate any advice from you and others on this board concerning medication, because I must have a plan B if this doesn't work
doxogenic
Posted by Phillipa on August 31, 2009, at 11:05:19
In reply to Re: My medication history 1994 to 2009 » SLS, posted by doxogenic boy on August 31, 2009, at 5:31:21
Welcome to babble so far a lot of good advise. Phillipa
Posted by floatingbridge on August 31, 2009, at 12:38:11
In reply to Re: My medication history 1994 to 2009 » SLS, posted by doxogenic boy on August 31, 2009, at 5:31:21
That's abilify, right? What dosage was discussed? Keep on keeping on,
kind regards and healing thoughts,
fb
Posted by doxogenic boy on August 31, 2009, at 17:11:58
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by SLS on August 31, 2009, at 4:38:14
> How did you respond to clomipramine and venlafaxine?
Some additional information about venlafaxine:
Started 15th of May 2002.
27th of June 2002: 450 mg daily
Used 450 mg/day till January 2003, discontinued February same year. (Tapered down gradually, and stopped with clonazepam at the same time).Venlafaxine worked OK, but pooped out, such as
all SSRIs and SNRIs. I am sorry that I can't remember more in detail. Generally, I can say that I have discontinued meds because of
either1)More anxiety and/or worsening of depression
2)Lack of effect
3)Loss of effect or
4)Unbearable side effects.But it is possible that some meds can be given a new trial, because the illness can have been changed and they can work different with my current cocktail.
I haven't much notes about response and side effects from my meds, mostly it is just the doses.
I remember better the best and worst experiences with my meds.
There are probably some meds I could have used longer before I declared it as a failed trial, but if the illness is getting worse, I haven't much choice but to stop it before it is getting dangerous.
> Did you find Prozac helpful at all? 60mg?
Correction to myself:
I couldn't find any higher dose than 40 mg.
Started with fluoxetine 17th of July 2001,
stopped in February 2002.
Before the fluoxetine, I used nortriptyline ("Noritren" in my country) for about five months.
It had some effect, but I wasn't satisfied.The only SSRI that had no effect at all, was sertraline in 2004 from 29th of September, gradually up to 200 mg.
It seems like my depression doesn't respond to SSRIs in monotherapy any longer.
I suppose a depression can be more treatment resistant when one has used a lot of meds and have been ill for a long time.
I have taken 0,088 mg X 2 of pramipexole today, increases to 0,088 X 3 tomorrow.
Can quetiapine block the effect of pramipexole?What about tranylcypromine + trimipramine + tianeptine + quetiapine?
Do you have any advice to what I can do next?
doxogenic
Posted by doxogenic boy on August 31, 2009, at 17:16:48
In reply to Re: My medication history 1994 to 2009, posted by Phillipa on August 31, 2009, at 11:05:19
> Welcome to babble so far a lot of good advise. Phillipa
Yes, it has been helpful already, also because when I write here, I have something to do that I like.
doxogenic
Posted by doxogenic boy on August 31, 2009, at 17:31:33
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by floatingbridge on August 31, 2009, at 12:38:11
> That's abilify, right?
Pramipexole is Sifrol in my country (and I think, Mirapex in the USA).
It is a problem I don't have a good solution for, when trade names are different in USA and other countries. The generic names are usually the same, so therefore I use them.
> What dosage was discussed?
0,088 mg pramipexole X 3 daily.
> Keep on keeping on,
>
> kind regards and healing thoughts,Thanks, I will keep on trying. I haven't had any side effect so far.
doxogenic
Posted by SLS on August 31, 2009, at 17:42:03
In reply to Re: My medication history 1994 to 2009 » SLS, posted by doxogenic boy on August 31, 2009, at 17:11:58
This is what I am currently taking:
tranylcypromine (Parnate) 80mg
nortriptyline (Pamelor) 150mg
lamotrigine (Lamictal) 200mg
aripiprazole (Abilify) 20mg
lithium 450mg
You might want to choose the SRI antidepressant that has worked best and still remains tolerable - venlafaxine (Effexor) perhaps - and add a full therapeutic dose of nortriptyline. It would be interesting to add lithium to this if necessary. Once you have established this core treatment, then you can try adding other augmenters like low-dose ziprasodone (Geodon).
- Scott
Posted by floatingbridge on August 31, 2009, at 21:35:26
In reply to Re: My medication history 1994 to 2009 » floatingbridge, posted by doxogenic boy on August 31, 2009, at 17:31:33
Hi Doxogenic boy,
Let us know how the sifrol goes. I've been wondering about mirapex....
glad no side effects--now for some positive ones!
fb
Posted by doxogenic boy on September 2, 2009, at 15:23:32
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by SLS on August 31, 2009, at 17:42:03
> This is what I am currently taking:
>
> tranylcypromine (Parnate) 80mg
> nortriptyline (Pamelor) 150mg
> lamotrigine (Lamictal) 200mg
> aripiprazole (Abilify) 20mg
> lithium 450mg
>
>
> You might want to choose the SRI antidepressant that has worked best and still remains
tolerable - venlafaxine (Effexor) perhaps - and add a full therapeutic dose of nortriptyline. It would be interesting to add lithium to this if necessary. Once you have established this core treatment, then you can try adding other augmenters like low-dose ziprasodone (Geodon).
--------------------Thanks for the advice, I will think about it.
My current combination is:
1) quetiapine (Seroquel) 600 mg
2) liothyronine sodium (L-isomer of triiodothyronine (T3); Cytomel, Liothyronin)
20 µg (microgram)
3) escitalopram (Cipralex/Lexapro) 40 mg
4) tianeptine (Stablon) 150 mg
5) clonazepam (Klonopin, Rivotril) 1 mg
6) trimipramine (Surmontil) 100 mg
7) pramipexole (Sifrol/Mirapex) 0.264 mg
(0.088 mg X 3)
I started with the pramipexole Monday. What could be the first thing to do?doxogenic
Posted by doxogenic boy on September 2, 2009, at 15:34:39
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by floatingbridge on August 31, 2009, at 21:35:26
> Hi Doxogenic boy,
>
> Let us know how the sifrol goes. I've been wondering about mirapex....
>
> glad no side effects--now for some positive ones!
-----------------This is my third day with pramipexole (Sifrol, Mirapex) 0,088 mg X 3.
Yesterday and today I have had anxiety more of the time than before I started with it. Could it be a side effect? It is hard to come through the anxious time of the day, so I wonder how long I can endure it, if it is a side effect of pramipexole.
How long time does it take for pramipexole to show effect, and what kind of effect can I expect?
doxogenic
Posted by floatingbridge on September 2, 2009, at 15:48:51
In reply to Re: My medication history 1994 to 2009 » floatingbridge, posted by doxogenic boy on September 2, 2009, at 15:34:39
Doxogenic,
Have you googled it on askapatient.com? They have information on responses and effectiveness.
The anxiety does not sound good, though....
fb
Posted by SLS on September 2, 2009, at 16:13:25
In reply to Re: My medication history 1994 to 2009 » SLS, posted by doxogenic boy on September 2, 2009, at 15:23:32
> > This is what I am currently taking:
> >
> > tranylcypromine (Parnate) 80mg
> > nortriptyline (Pamelor) 150mg
> > lamotrigine (Lamictal) 200mg
> > aripiprazole (Abilify) 20mg
> > lithium 450mg
> >
> >
> > You might want to choose the SRI antidepressant that has worked best and still remains
> tolerable - venlafaxine (Effexor) perhaps - and add a full therapeutic dose of nortriptyline. It would be interesting to add lithium to this if necessary. Once you have established this core treatment, then you can try adding other augmenters like low-dose ziprasodone (Geodon).
> --------------------
>
> Thanks for the advice, I will think about it.
>
> My current combination is:
>
> 1) quetiapine (Seroquel) 600 mg
> 2) liothyronine sodium (L-isomer of triiodothyronine (T3); Cytomel, Liothyronin)
> 20 µg (microgram)
> 3) escitalopram (Cipralex/Lexapro) 40 mg
> 4) tianeptine (Stablon) 150 mg
> 5) clonazepam (Klonopin, Rivotril) 1 mg
> 6) trimipramine (Surmontil) 100 mg
> 7) pramipexole (Sifrol/Mirapex) 0.264 mg
> (0.088 mg X 3)
>
>
> I started with the pramipexole Monday. What could be the first thing to do?
>
> doxogenic
If you haven't tried adding Wellbutrin (bupropion), I would make that the first stop after your trial with pramipexole.Just to let you know, I respond better to nortriptyine than I did with trimipramine.
How would you describe your illness?
I guess insomnia and anxiety are big issues? If they are, then you might want to take this into consideration if you choose to explore Wellbutrin. I would try it anyway. If your anxiety becomes significantly worse, you just stop taking it. No biggie. It is just that I have seen Wellbutrin work particularly well with escitalopram.
I am not big on tianeptine. I haven't seen it bring someone to remission yet. Of course, my only exposure to people who have tried tianeptine is here on Psycho-Babble. Is it worth taking for its neuroprotection? That's a tough decision. Although I am doing better on lithium now, I had intended to take it indefinitely, regardless of response or non-response, just for the neuroprotection and neurogenesis it might afford.
- Scott
Posted by doxogenic boy on September 3, 2009, at 16:27:16
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by SLS on September 2, 2009, at 16:13:25
> > > This is what I am currently taking:
> > >
> > > tranylcypromine (Parnate) 80mg
> > > nortriptyline (Pamelor) 150mg
> > > lamotrigine (Lamictal) 200mg
> > > aripiprazole (Abilify) 20mg
> > > lithium 450mg
> > >
> > >
> > > You might want to choose the SRI antidepressant that has worked best and still remains
> > tolerable - venlafaxine (Effexor) perhaps - and add a full therapeutic dose of nortriptyline. It would be interesting to add lithium to this if necessary. Once you have established this core treatment, then you can try adding other augmenters like low-dose ziprasodone (Geodon).
> > --------------------
> >
> > Thanks for the advice, I will think about it.
> >
> > My current combination is:
> >
> > 1) quetiapine (Seroquel) 600 mg
> > 2) liothyronine sodium (L-isomer of triiodothyronine (T3); Cytomel, Liothyronin)
> > 20 µg (microgram)
> > 3) escitalopram (Cipralex/Lexapro) 40 mg
> > 4) tianeptine (Stablon) 150 mg
> > 5) clonazepam (Klonopin, Rivotril) 1 mg
> > 6) trimipramine (Surmontil) 100 mg
> > 7) pramipexole (Sifrol/Mirapex) 0.264 mg
> > (0.088 mg X 3)
> >
> >
> > I started with the pramipexole Monday. What could be the first thing to do?
> >
> > doxogenic
>
>
> If you haven't tried adding Wellbutrin (bupropion), I would make that the first stop after your trial with pramipexole.
------------I have tried bupropion as monotherapy. It was activating, but after some months, it made my anxiety worse, and it lost its effect. When I used bupropion, my memory was very bad. I also have tried bupropion with bromocriptine (Parlodel), but that did not make the situation better
Bupropion may have another effect with my current combo, so I will take it into account.
> Just to let you know, I respond better to nortriptyine than I did with trimipramine.
The reason I started trimipramine, was that it probably would give more sleep and less anxiety. Isn't nortriptyline more activating and (thus?) more anxiety-provoking than trimipramine?
> How would you describe your illness?Ambivalence, excessive worriyng, anxiety, anhedonia/lack of motivation, interest.
Small details can be insurmountable and endless problems, which make it impossible to get anything done. Lots of things I should have done, accumulates for years.> I guess insomnia and anxiety are big issues?
Insomnia isnt any longer, because of quetiapine, clonazepam and probably also trimipramine, but anxiety is still a big issue.
> If they are, then you might want to take this into consideration if you choose to explore Wellbutrin. I would try it anyway. If your anxiety becomes significantly worse, you just stop taking it. No biggie. It is just that I have seen Wellbutrin work particularly well with escitalopram.Interesting. I will certainly think about this.
> I am not big on tianeptine. I haven't seen it bring someone to remission yet.My medication history the latest years, is a story about partial remission.
Big steps have been done with my current combo, but there is still a _long_ way to remission. For me, high-dose tianeptine added to high-dose escitalopram (and the other meds) made a big difference, and the strange thing is, that this improvement has been there for a long time.
The first thing that worked for more than two years in hopeless anxiety, was quetiapine; it was and is anxiolytic and good for my sleep. I can now sleep 10-12 hours, but when I was almost entirely medication-free for half a year, I slept just 5 hours.Months with sleep restriction therapy didnt work. A polysomnographic investigation in 2005 showed that I have periodic limb movements during sleep, so maybe the pramipexole can improve my sleep quality.
> Of course, my only exposure to people who have tried tianeptine is here on Psycho-Babble.Have anyone tried an SSRI first, then adding tianeptine up to, for instance, 150 mg?
> Is it worth taking for its neuroprotection? That's a tough decision. Although I am doing better on lithium now, I had intended to take it indefinitely, regardless of response or non-response, just for the neuroprotection and neurogenesis it might afford.
I get tianeptine nearly for free in my country, so if it has some effect and no bad interactions, it is for me no reason not to take it.
Thanks for the advice!doxogenic
Posted by doxogenic boy on September 3, 2009, at 16:55:22
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by floatingbridge on September 2, 2009, at 15:48:51
> Doxogenic,
>
> Have you googled it on askapatient.com? They have information on responses and effectiveness.I found that it certainly can lead to anxiety, but I didn't find out how fast the anxiety can come. If it is just as bad tomorrow too, I must think about giving it up. But I wonder if hydromorphone (Palladon/Dilaudid) can work against the anxiety from Mirapex?
This evening, the side effects from pramipexole (Sifrol, Mirapex) actually have changed: the anxiety is being partially mixed with a feeling of energy. But from other experiences with good evenings, the anxiety may come back tomorrow.
http://www.askapatient.com/viewrating.asp?drug=20667&name=MIRAPEX
I also looked here:
http://www.revolutionhealth.com/drugs-treatments/rating/mirapex-for-depressiondoxogenic
Posted by SLS on September 4, 2009, at 8:34:30
In reply to Re: My medication history 1994 to 2009 » SLS, posted by doxogenic boy on September 3, 2009, at 16:27:16
Hi.
I wrote a long post in response to yours, but lost it.
To summarise:
Keep the tianeptine and escitalopram since they are working for you.
1. I wouldn't bother with Wellbutrin again at this juncture. It will probably treat you the same as it has in the past.
2. You could try adding Remeron right now and use dosages between 45-75mg. Most doctors allow their patients to languish at 30mg. This is silly.
3. It sounds like you might be a tricyclic responder. Switch to a TCA with a better track record for treating depression. You could taper the trimipramine gradually while titrating drugs like amitriptyline, doxepin, or nortriptyline. Nortriptyline does not increase anxiety in most people.
4. You could try adding low-dose lithium in the dosage range of 300-600mg. You will know within two weeks whether or not it will be of any value. For those people who are use it as an augmenter of antidepressants, it can work as soon as a few days. It is hard for me not to recommend lithium as an adjunct worth a quick trial because I am currently having success with it.
- Scott
Posted by doxogenic boy on September 4, 2009, at 14:29:52
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by SLS on September 4, 2009, at 8:34:30
> Hi.
>
> I wrote a long post in response to yours, but lost it.
Thanks for your work with it.
> To summarise:
>
> Keep the tianeptine and escitalopram since they are working for you.
>
> 1. I wouldn't bother with Wellbutrin again at this juncture. It will probably treat you the same as it has in the past.
>
> 2. You could try adding Remeron right now and use dosages between 45-75mg. Most doctors allow their patients to languish at 30mg. This is silly.
Can Remeron work with my current combination when the somewhat similar mianserin (Tolvon) up to 180 mg in combination with paroxetine 60 mg (spring 1996) didn't work?I tried Remeron with sertraline November 2004, and I woke up early in the morning and felt so hungry that I had to stand up eating, if I wanted to sleep any longer. When I used mianserin, I gained many kilos, Remeron didn't I try so long.
> 3. It sounds like you might be a tricyclic responder. Switch to a TCA with a better track record for treating depression. You could taper the trimipramine gradually while titrating drugs like amitriptyline, doxepin, or nortriptyline. Nortriptyline does not increase anxiety in most people.OK.
> 4. You could try adding low-dose lithium in the dosage range of 300-600mg. You will know within two weeks whether or not it will be of any value. For those people who are use it as an augmenter of antidepressants, it can work as soon as a few days.
How does it feel, if low-dose lithium works, as augmenter of antidepressants? Does it work against anxiety, anhedonia, worrying and does it make you feel calm and/or more motivated?
I tried lithium in 1994/95, about half a year, then I had a manic-depressive (bipolar) diagnosis (it was replaced by a recurrent depressive disorder diagnosis about ten years ago).
My blood levels was measured, so it was in the therapeutic window for bipolar patients.
I felt indifferent, and except of the first two months, I had a "stable" depression and it made me indifferent. I felt free and better when I discontinued it. But a low-dose lithium treatment may be better, even with my bad experiences?
> It is hard for me not to recommend lithium as an adjunct worth a quick trial because I am currently having success with it.OK. I have heard that a lot of people here where I live have found quetiapine (Seroquel) helpful.
It has both hypnotic, anxiolytic, antidepressive and mood-stabilizing properties, and it has worked like that for me, to some extent. With all my medication trials, it seems that keeping meds that have some effect, is the best I currently can reach.I have a partial response to my current mix, and even though that still is bad, it is heaven compared to the worst anxiety/depression period August 2004 to December 2006.
A problem I still have, is that I am very depressed the first half or 3/4 of the day and have many mood swings each day (not hypomanic, just depressed/anxious and less depressed/anxious)
Is it possible to get rid of that without becoming blunt?
doxogenic
Posted by SLS on September 4, 2009, at 16:40:03
In reply to Re: My medication history 1994 to 2009 » SLS, posted by doxogenic boy on September 4, 2009, at 14:29:52
> > Hi.
> >
> > I wrote a long post in response to yours, but lost it.
>
>
> Thanks for your work with it.
>
>
> > To summarise:
> >
> > Keep the tianeptine and escitalopram since they are working for you.
> >
> > 1. I wouldn't bother with Wellbutrin again at this juncture. It will probably treat you the same as it has in the past.
> >
> > 2. You could try adding Remeron right now and use dosages between 45-75mg. Most doctors allow their patients to languish at 30mg. This is silly.> Can Remeron work with my current combination when the somewhat similar mianserin (Tolvon) up to 180 mg in combination with paroxetine 60 mg (spring 1996) didn't work?
Ok. Forget Remeron.
> > 3. It sounds like you might be a tricyclic responder. Switch to a TCA with a better track record for treating depression. You could taper the trimipramine gradually while titrating drugs like amitriptyline, doxepin, or nortriptyline. Nortriptyline does not increase anxiety in most people.
> OK.
> > 4. You could try adding low-dose lithium in the dosage range of 300-600mg. You will know within two weeks whether or not it will be of any value. For those people who are use it as an augmenter of antidepressants, it can work as soon as a few days.
> How does it feel, if low-dose lithium works, as augmenter of antidepressants? Does it work against anxiety, anhedonia, worrying and does it make you feel calm and/or more motivated?If it works, you should find that most of your symptoms improve, including anhedonia and motivation. It should also reduce your worrying and anxiety, as long as those things are part of your depression, and not a separate set of disorders. One caveat: You might not see improvements in anhedonia and interest right away. Energy and the ability to initiate activities seem to improve first. I can't make any guarantees, of course, but if you hit the right targets, you should find all of your symptoms improve.
> I tried lithium in 1994/95, about half a year, then I had a manic-depressive (bipolar) diagnosis (it was replaced by a recurrent depressive disorder diagnosis about ten years ago).
I have tried high-dose lithium several times in the past to no avail. It was only when I discovered the other drugs in my treatment regime first that lithium produced a pronounced antidepressant effect. If lithium is not combined with the right adjunct drugs, it may not help.
> My blood levels was measured, so it was in the therapeutic window for bipolar patients.
> I felt indifferent, and except of the first two months, I had a "stable" depression and it made me indifferent. I felt free and better when I discontinued it. But a low-dose lithium treatment may be better, even with my bad experiences?I feel crappy at 600mg. I feel great at 450mg. The higher dosages make me feel "washed out" and unmotivated. Even more depressed.
> OK. I have heard that a lot of people here where I live have found quetiapine (Seroquel) helpful.
Each person has a unique neurobiology. I have seen Seroquel make an enormous difference in one person, and make another dysphoric and irritable. If you can get past the initial anxiety, insomnia, and feelings of restlessness, Abilify might be worth trying. It seems to stabilize dopaminergic neurotransmission. Geodon is another AP that has shown antidepressant properties.
> It <Seroquel> has both hypnotic, anxiolytic, antidepressive and mood-stabilizing properties, and it has worked like that for me, to some extent. With all my medication trials, it seems that keeping meds that have some effect, is the best I currently can reach.
Keep the Seroquel. If you ever become interested in Abilify or Geodon, you can simply add them to Seroquel for a quick trial. You should know by two weeks whether the new AP will be helpful.
> I have a partial response to my current mix, and even though that still is bad, it is heaven compared to the worst anxiety/depression period August 2004 to December 2006.
I understand completely. You don't have to settle, though. You simply try to build your treatment around the core of drugs that you already know help. In my mind, there are two types of core treatments:
1. Serotonin reuptake inhibitors
2. MAOI without serotonin reuptake inhibitors.With MAOIs, you have limitations as to what you can add to them. This means that you can't use any drug with substantial serotonin reuptake inhibition. You can combine some tricyclics and Wellbutrin with MAOIs. With either core treatment, you can begin to try adding APs (with the possible exception of Geodon), lithium, stimulants, dopamine agonists, buspirone, etc.
> A problem I still have, is that I am very depressed the first half or 3/4 of the day and have many mood swings each day (not hypomanic, just depressed/anxious and less depressed/anxious)
You sound like a tricyclic responder. I would try adding a TCA to the SRI drug you feel helps the most. You can then add low-dose lithium if the results of the TCA trial are not robust. Keep the TCA, though, at least until you try adding lithium to it.
- Scott
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