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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by SLS on May 7, 2021, at 8:48:02
This might be the magic potion for me.
Nardil: 105 mg/day
Nortriptyline: 100 mg/day
Lamictal: 300 mg/day
Lithium: 300 mg/day
This is the f*ck*d-up thing that I must accept, though. I am 61 years old now. In 1996, Lamictal was approved by the FDA. Lamictal was the last drug necessary for my cure (remission). I was 36 years old then.That's one hell of a bitter pill to swallow. When I first "woke up", I was unimaginably grateful. I never thought I would get here after 39 years of assaulting my poor brain with synthetic chemicals. I became ill abruptly at age 17, 44 years ago.
No guarantees, of course. I would say that Nardil poops out more often than Parnate, but I am far from certain about that. Even so, a remission with Nardil can last for years - or even life.
I haven't posted much in the last year because I could never be certain that I would reach remission with the episodic course of my response to the lower dosage of Nardil. I wanted to wait until I was more sure of my destination before reporting anything. It was kind of personal.
I am one lucky MF. This was the LAST treatment that remained unexplored. A previous attempt with this same combination in 2007 used insufficiently high dosages of Nardil and Lamictal. I swear, this was the last alternative on the list. Either I was to be reborn at age 61, or perhaps not living to age 62.
Lithium at 300 mg/day gave me a mild, but immediate improvement upon beginning treatment at 300 mg/day. Lithium at dosages of 450 mg/day and higher make me MORE depressed. I always hated lithium for that. I decided to add it at 300 mg/day rather than 1200 mg/day based on a few things I read. Months later, when it was unclear whether it was still helping in the treatment of my presumably bipolar depression, I decided to keep taking it to prevent Alzheimer's Dementia. Little did I know that my mother should be stricken with Alzheimer's 10 years later.
I don't know if any other doctor in the area was as able to "think outside the box" and be more aggressive than he was. He worked with me more as a colleague than a passive patient. He was willing to allow me to go up to 120 mg/day of Nardil if necessary. I hope it's not.
The best way I can describe my experience is to use The Wizard of Oz as a metaphor, provided youve seen it. Of course, the movie starts out in black-and-white. Everything is a drab and dirty gray. The wind kicks up dust from the road. The farm is depressing. Ominous clouds fill the sky and a tornado drops down to the ground in the distance. Without warning, the house is hit by the tornado and is carried upwards into the sky. When the house finally lands abruptly, Dorothy grabs her dog, Toto, and heads for the black-and-white front door. When she opens it, the world explodes in Technicolor.
I feel that this is a very important way that we should all conceptualize our psychobiological illnesses:
While we are ill, we live in an ALTERED STATE OF CONSCIOUSNESS. Nothing short of this is an adequate description.
- Scott
Posted by rjlockhart37 on May 7, 2021, at 9:57:58
In reply to The magic potion for me., posted by SLS on May 7, 2021, at 8:48:02
SLS
That sounds good, nardil is potent. I take Lamictal 400mg in the morning with Prozac, it does keep depressive phases away. It's not actually a antidepressant but i notice it keeps me out of depression slumps, or it prevents themI wanted to ask about Lithium, i took it in a psych, i was taking 150mg capsule twice (300mg daily) but my doctor said that was low dose, and sasid 300mg in morning and at night was more effective. So, i wanted to ask, taking 300mg in morning and 300mg at night, would that make me depressed?
Posted by rjlockhart37 on May 7, 2021, at 10:00:17
In reply to Re: The magic potion for me., posted by rjlockhart37 on May 7, 2021, at 9:57:58
that would be 600mg daily - both capsules
Posted by undopaminergic on May 7, 2021, at 10:40:24
In reply to Re: The magic potion for me., posted by rjlockhart37 on May 7, 2021, at 9:57:58
>
> I wanted to ask about Lithium, i took it in a psych, i was taking 150mg capsule twice (300mg daily) but my doctor said that was low dose, and sasid 300mg in morning and at night was more effective. So, i wanted to ask, taking 300mg in morning and 300mg at night, would that make me depressed?
>You'd have to try it to find out. There's no way to predict it.
-undopaminergic
Posted by SLS on May 7, 2021, at 13:34:52
In reply to Re: The magic potion for me., posted by undopaminergic on May 7, 2021, at 10:40:24
> >
> > I wanted to ask about Lithium, i took it in a psych, i was taking 150mg capsule twice (300mg daily) but my doctor said that was low dose, and sasid 300mg in morning and at night was more effective. So, i wanted to ask, taking 300mg in morning and 300mg at night, would that make me depressed?
> >
>
> You'd have to try it to find out. There's no way to predict it.
>
> -undopaminergic
>Interestingly, lithium has a biphasic response curve for my depression. This has been reported elsewhere. It just so happens that lithium also has a biphasic effect on glutamate activity that reflects these clinical effects. Low dosages increase glutamatergic activity while high dosages reduce it.
- Scott
Posted by PeterMartin on May 7, 2021, at 20:35:57
In reply to Re: The magic potion for me., posted by SLS on May 7, 2021, at 13:34:52
Awesome to read that you're doing well Scott, and thanks for coming back to let us know the cocktail (I think we're all always looking).
Which generic of Lamictal did you settle on? I'm still a bit hung up on that for my own situation.
Also, in case you didn't see a post of mine above, I'd take a look into Rybelsus for Nardil weight gain. It's a GLP-1 agonist. It's not yet approved for weight loss, but the studies have been super positive and I'm almost certain it will be another year or two. I've lost 15lbs in 7weeks which is unheard of for me (on Marplan, Lamictal, and low dose Seroquel).
Now that I'm on Rybelsus I may try to give Nardil another go. The weight gain was an issue for me and I'm not sure if combining it w/ Metformin may have kept it slightly inconsistent for me (as I found it).
Thanks for any info on the Lamictal generic you take.
Posted by Phillipa on May 7, 2021, at 21:04:32
In reply to Re: The magic potion for me., posted by SLS on May 7, 2021, at 13:34:52
Scott are you in remission now? I do so hope you are Phillipa
Posted by sigismund on May 7, 2021, at 22:57:06
In reply to The magic potion for me., posted by SLS on May 7, 2021, at 8:48:02
Can I recall you saying that in the past in a desire for improvement you adjusted things in ways you subsequently regretted?
Don't do that, and good luck.
Posted by sigismund on May 7, 2021, at 23:02:11
In reply to Re: The magic potion for me. » SLS, posted by sigismund on May 7, 2021, at 22:57:06
Did Nardil once make you feel a little unstable? No signs of mania? (about which I have zero experience.)
It is so precious to have some relief.
Posted by Phillipa on May 7, 2021, at 23:26:32
In reply to Re: The magic potion for me., posted by sigismund on May 7, 2021, at 23:02:11
Hi Sigi Phillipa
Posted by sigismund on May 8, 2021, at 0:35:35
In reply to Re: The magic potion for me. » sigismund, posted by Phillipa on May 7, 2021, at 23:26:32
G'day Phillipa
Posted by rjlockhart37 on May 8, 2021, at 22:45:23
In reply to Re: The magic potion for me. » Phillipa, posted by sigismund on May 8, 2021, at 0:35:35
prozac and lamictal seem to help me through the day
Posted by SLS on May 9, 2021, at 8:01:51
In reply to Re: The magic potion for me., posted by PeterMartin on May 7, 2021, at 20:35:57
Hi, Peter.
> Awesome to read that you're doing well Scott, and thanks for coming back to let us know the cocktail (I think we're all always looking).
>
> Which generic of Lamictal did you settle on? I'm still a bit hung up on that for my own situation.
>
> Also, in case you didn't see a post of mine above, I'd take a look into Rybelsus for Nardil weight gain. It's a GLP-1 agonist. It's not yet approved for weight loss, but the studies have been super positive and I'm almost certain it will be another year or two. I've lost 15lbs in 7weeks which is unheard of for me (on Marplan, Lamictal, and low dose Seroquel).
>
> Now that I'm on Rybelsus I may try to give Nardil another go. The weight gain was an issue for me and I'm not sure if combining it w/ Metformin may have kept it slightly inconsistent for me (as I found it).
>
> Thanks for any info on the Lamictal generic you take.Thanks for the tip on Rybelsus. Do you know anyone taking Nardil who was successful with weight control.
Regarding Lamictal (lamotrigine), I take the GSK name brand. The price is disgusting, but I was able to get an exception on my insurance. I described that I had tried two generic brands, and they didn't work. Lucky.
I have just started looking for the best generic brand myself. I may not get another exception this year.
I found the original Teva (orange) to be the better of the generics I tried. I would go back to it, except it is no longer available. Teva replaced it with the product made by the manufacturer that it acquired - lamotrigine XR.
Have you ever heard of a lamotrigine product called Subvenite by OWP Pharmaceuticals?
This is the phone number they give if your pharmacy is having a problem getting it:
1-800-273-6729
For you so far, which generic is the best and which is the worst?
How was the best different from Lamictal?
I found Mylan to be the worst. I had to go from 300 mg/day to 500 mg/day to get anything close to the desired effect, and it had some uncomfortable psychiatric side effects. I have not tried Dr. Reddys.
Regarding Nardil weight gain, are you eating more or has your metabolism slowed down?I hope you find a brand of lamotrigine that does the trick for you.
- Scott
Posted by SLS on May 9, 2021, at 8:10:48
In reply to Re: The magic potion for me. » SLS, posted by Phillipa on May 7, 2021, at 21:04:32
Hi, Jan.
> Scott are you in remission now? I do so hope you are Phillipa
Not totally. I had been taking Nardil at 90 mg/day for months. It was a daily rollercoaster ride. The magnitude of improvement could change several times a day. I raised the dosage to 105 mg/day a few days ago. The immediate result was to abolish the rollercoaster changes. Now, I have to wait at least 3 weeks before evaluating the trajectory of improvement.
I had experienced a state approaching complete remission on and off at 90 mg/day.
From what I have gathered, the usual effective range for Nardil dosage is between 60-90 mg/day. 120 mg/day seems to be the maximum.
- Scott
Posted by SLS on May 9, 2021, at 8:18:28
In reply to Re: The magic potion for me. » SLS, posted by sigismund on May 7, 2021, at 22:57:06
Hi, Sigi.
> Can I recall you saying that in the past in a desire for improvement you adjusted things in ways you subsequently regretted?
>
> Don't do that, and good luck.
Over the years, I have envied your memory.Yes. I did do that. I was absolutely reckless. I will take your advice this time.
Nardil is a deceptive drug. One can feel an improvement immediately after increasing OR decreasing the dosage. If that initial rush disappears, I have learned that this is not an indicator that further dosage increases will be necessary. I think one must wait at least 3 weeks before evaluating their response. Some people don't experience a robust improvement on Nardil until they have been taking it for 3 months.
Thanks. :-)
- Scott
Posted by SLS on May 9, 2021, at 8:35:20
In reply to Re: The magic potion for me., posted by sigismund on May 7, 2021, at 23:02:11
Hi, again.
> Did Nardil once make you feel a little unstable? No signs of mania? (about which I have zero experience.)
Nardil and Parnate have been involved in all of the few manic episodes (psychotic) that were triggered. I have never experienced anything remotely like that in my baseline untreated depression or with drugs other than MAOIs. Of the two, I found Nardil to be the greater offender. I think the rollercoaster ride I described in the post above represented a destabilization. I think I might have been hypomanic for a few days.
> It is so precious to have some relief.
This is precisely what drove my reckless behavior with Nardil. Once I feel better and then begin to deteriorate again, I will do *anything* to get relief again. The return of depression is like having your hand forced over a flame. You will do anything to pull it out as fast as you can.
Again, I would emphasize that, although the lithium might not add to my current robust response, I continue to take 300 mg/day to prevent Alzheimer's. There is a bunch of literature that indicates that lithium can not only prevent, but also reduce the rate of deterioration. Who knows if these reports and speculations are accurate, but at the dosages they claim to see this association, people should generally not be concerned about side effects. There is almost no chance to experience kidney or thyroid damage. These reports describe people taking very small dosages to receive the prophylaxis against Alzheimer's. I think 100 mg is the smallest dose available. Even 150 mg/day is plenty.
I really do appreciate your concern, Sigi. And I thank God for your memory.
- Scott
Posted by SLS on May 9, 2021, at 8:37:41
In reply to Re: The magic potion for me., posted by rjlockhart37 on May 8, 2021, at 22:45:23
Hi, RJ.
> prozac and lamictal seem to help me through the day
Doctors are becoming more comfortable using 60 mg/day of Prozac (fluoxetine). Don't give up on it without exploring this higher dosage.
Good luck, buddy.
- Scott
Posted by Phillipa on May 9, 2021, at 9:39:24
In reply to Re: The magic potion for me. » Phillipa, posted by SLS on May 9, 2021, at 8:10:48
Scott fantastic Phillipa
Posted by rjlockhart37 on May 9, 2021, at 12:16:57
In reply to Re: The magic potion for me. » rjlockhart37, posted by SLS on May 9, 2021, at 8:37:41
Scott
I take 80mg Prozac, i was on 60, my doctor finally said we'll go up to 80. She kept saying 80 would make me flat, or apathic. But...it didnt the dose works for me at keeping depression away. If i don't take it at that doseage is ineffective.
gives... a feeling, somewhat happiness, it makes things seem 'ok'. I'll be going through the day, and ill feel the prozac work, serotonin feeling. When i missed prozac, deep depression. I've been on 16 years, still working. They say it's less effective SSRI, the 'least' selective compared to paxil which the most selective. That's why it's withdrawls are not bad, compared to other SSRI's it has very very long half life. That's all i'll write. Hope things still get better for me
Posted by Lamdage22 on May 12, 2021, at 4:22:27
In reply to The magic potion for me., posted by SLS on May 7, 2021, at 8:48:02
61 isn't that bad. You still got time to enjoy. Maybe pick up exercise if you can. It'll make you feel younger and no one argues about the fact that it helps mood, either.
Posted by beckett2 on May 12, 2021, at 13:41:04
In reply to The magic potion for me., posted by SLS on May 7, 2021, at 8:48:02
This is terrific news, Scott, and I'm happy to hear it. Lamotrigine has made a big difference in my life.
Yay!
Posted by SLS on May 12, 2021, at 23:36:07
In reply to Re: The magic potion for me., posted by beckett2 on May 12, 2021, at 13:41:04
Hi, Beckett22
> This is terrific news, Scott, and I'm happy to hear it. Lamotrigine has made a big difference in my life.
>
> Yay!Yay!
Thanks.
:)
- Scott
Posted by SLS on May 14, 2021, at 15:19:15
In reply to Re: The magic potion for me., posted by beckett2 on May 12, 2021, at 13:41:04
Hi, Beckett
> This is terrific news, Scott, and I'm happy to hear it.
Thanks. :-)
> Lamotrigine has made a big difference in my life.
I'm glad you can move forward now.
What brand of lamotrigine do you take?
- Scott
Posted by beckett2 on May 14, 2021, at 19:05:19
In reply to Re: The magic potion for me. » beckett2, posted by SLS on May 14, 2021, at 15:19:15
> Hi, Beckett
>
> > This is terrific news, Scott, and I'm happy to hear it.
>
> Thanks. :-)
>
> > Lamotrigine has made a big difference in my life.
>
> I'm glad you can move forward now.
>
> What brand of lamotrigine do you take?
>
>
> - ScottUnichem. I haven't had trouble with different manufacturers, although I haven't taken all, and I've only taken generics.
Posted by SLS on May 15, 2021, at 15:09:11
In reply to The magic potion for me., posted by SLS on May 7, 2021, at 8:48:02
> This might be the magic potion for me.
>
> Nardil: 105 mg/day
> Nortriptyline: 100 mg/day
> Lamictal: 300 mg/day
> Lithium: 300 mg/day
Well, I raised the dosage of Nardil from 105 mg/day to 120 mg/day. I felt better by the end of yesterday, but I have learned to not come to any conclusions about Nardil dosage based upon the immediate improvement I receive. Within a few hours of taking more Nardil, I feel better. However, the improvement lasts for only a fraction of a day. Once I begin to lose that initial response, I had assumed that I needed more. However, it seems that the deterioration in my condition is part of the process, but passes within a few days, leaving me with a significant, stable, improvement. I would also suggest that some people must wait for 3 months before Nardil produces a robust response.
- Scott
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