![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 34. Go back in thread:
Posted by conundrum on November 16, 2009, at 7:17:37
In reply to Re: calling all armchair psychs » Phidippus, posted by g_g_g_unit on November 16, 2009, at 3:44:24
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448202/
THis study shows that Methylphenidate has the strongest affinity for the dopamine transporter and then norepinephrine. It barely increases serotonin.
Dextroamphetamine has its strongest effect on norepinephrine and then dopamine. It also releases more serotonin than Methylphenidate.
Posted by Phidippus on November 16, 2009, at 8:49:49
In reply to Re: calling all armchair psychs » Phidippus, posted by g_g_g_unit on November 16, 2009, at 3:44:24
d-amphetamine tends to do most of its work in the PFC where it modulates glutamate-excressive glutamate in the PFC is implicated in OCD. Methylphenidate tends to do its work in the brain stem.
I did find something interesting though:
http://www.ncbi.nlm.nih.gov/pubmed/3429704
P
Posted by conundrum on November 16, 2009, at 9:12:41
In reply to Re: calling all armchair psychs » g_g_g_unit, posted by Phidippus on November 16, 2009, at 8:49:49
When you say it modulates glutamate, does it increase it or decrease it?
Posted by Phidippus on November 17, 2009, at 19:06:50
In reply to Re: calling all armchair psychs » Phidippus, posted by conundrum on November 16, 2009, at 9:12:41
> When you say it modulates glutamate, does it increase it or decrease it?
Dextroamphetamine does not alter glutamate levels in the prefrontal cortex. This may be because dextroamphetamine increases dopamine release in the prefrontal cortex; activation of the dopamine-2 receptors inhibits glutamate release in the prefrontal cortex. However activation of the dopamine-1 receptors in the prefrontal cortex, increases glutamate leves in the nucleus accumbens. An increase of the glutamate levels in the nucleus accumbens may be part of the reason that dextroamphetamine has an ability to increase locomotor activity in rats. Serotonin may also play a role in dextroamphetamines affect on glutamate levels.
Posted by conundrum on November 18, 2009, at 22:40:12
In reply to calling all armchair psychs, posted by g_g_g_unit on November 8, 2009, at 4:26:41
Was there much of a time lapse between when you first took prozac and then Remeron? Its possible you are cognitively responding to the 5 HT2C antagonism of both drugs.
Perhaps you would have felt the same cognitive problems if you had stayed off prozac and not gone on remeron.
Who knows. I found that I had really bad sexual dysfunction on St. John's Wort and then taking lexapro made it somewhat better, and now I'm taking neither and it hasn't gotten worse. A human being is a complex organism.
Posted by g_g_g_unit on November 18, 2009, at 23:31:18
In reply to Re: calling all armchair psychs » g_g_g_unit, posted by conundrum on November 18, 2009, at 22:40:12
> Was there much of a time lapse between when you first took prozac and then Remeron? Its possible you are cognitively responding to the 5 HT2C antagonism of both drugs.
no, i think there was about a week's lapse. the problem is that my cognition was okay prior to the whole Remeron thing. i had never really sought to treat my OCD - i basically just lived on my nerves. i was a lot slower in certain areas - it took me forever to finish books, etc. but i don't feel like my higher thinking abilities were really compromised. the fogginess i experience now (a kind of full-brain sensation - blurry vision, cottonwool head, etc.) is exactly what i had after i came off Remeron. when i took Prozac, i remember everything 'clearing up'. other SSRI's made it worse. i don't think Remeron caused brain damage or anything drastic like that, but i just wondered if like too much stress is placed on the frontal cortex, it can shut down or something? Remeron just felt like the nail in the coffin i guess.
>A human being is a complex organism.
i know. i feel really naive for even trying to find a throughline in this whole mess. but it's not like any doctor i see has proven anymore useful. they just keep trying to treat the 'original disease' (i.e. OCD) which has never really worked out - stamping out the OCD always seems to come at the expense of something else (drive, motivation, etc.).
my head feels like a complete mess now - i still ruminate, but i also feel like i have full-blown ADD, so it's like my OCD thoughts never reach a full crescendo (which is good), but i also can't focus on anything productive to save my life. it's totally depersonalizing, because i can never really finish my thoughts or engage in anything that requires sustained thinking (i was working as a writer, so that's incredibly important). my parents wants me to see a neurologist, but i don't know how much more help they'll be?
i'm not necessarily looking at trying to rid myself completely of my problems, but i want to get to a point where i can go back to work. i would rather treat the executive dysfunction over the OCD now.
like i say, low dose Memantine (where it's primarily a D2 agonist i think?) worked well, but was almost *too much* clarity. so i'm wondering if a little D2 agonism might be useful without pushing it too far... i also wonder if i can really get away without using an SSRI ..
so maybe low-dose Geodon, which i know psychobot is using with some success?
low-dose prozac (5mg?), where at least there's a little SRI action. is this working out okay for you conundrum? also, do you find low-dose buspar at all useful for cognition?
memantine + stimulant - though aside from the difficult of getting this prescribed, i wonder if it might just turn me into a logic-driven robot.
i also have some SAM-e which i might try experimenting with.
Posted by conundrum on November 19, 2009, at 6:49:15
In reply to Re: calling all armchair psychs » conundrum, posted by g_g_g_unit on November 18, 2009, at 23:31:18
I think memantine is a D2 agonist not antagonist. Anyway, what do you mean when you say too much clarity?
I noticed with 2.5 mg prozac it did nothing.
I then added 10mgs buspar. It did not improve cognition but it improved my motivation. I then bumped prozac to 5mgs a day. I've been on 5mgs for almost two weeks and it has reversed the positive effects of buspar and made me lazy. I feel tired on it, and there has been no improvement in cognition. I plan to take 30 mgs of buspar next week and see if I feel motivated again. The highest i'll go with prozac is 10mgs. If i don't start to feel hedonic and a cognitive improvement I'll stop. ACtually I'm very skeptical that will happen and wonder if I should just stop prozac now and stick with buspar in the mean time because I was getting things done on it.
I remember brainbeard said something about low dose prozac only being a 5 HT2C antagonist and not having much SRI but I don't think thats true. I'm not even sure where he found that fact, but perhaps its the opposite. Maybe its not until the higher doses that the 5 HT2C becomes noticable.
Posted by g_g_g_unit on November 19, 2009, at 21:11:33
In reply to Re: calling all armchair psychs » g_g_g_unit, posted by conundrum on November 19, 2009, at 6:49:15
> I think memantine is a D2 agonist not antagonist. Anyway, what do you mean when you say too much clarity?
sorry, i meant agonist. i guess without the NMDA inhibition, my mind just went kind of wild at 5mg - ideas were racing through my head faster than i could harness them, i had boundless intellectual energy, was a social titan etc. i guess it was probably hypomania? though drug-induced, in my opinion .. i don't believe i'm bipolar.
i met with an ADD specialist who has finally confirmed what i suspected for a while, and which problems explains why i never did well on SSRI's alone - namely, that i have comorbid ADD and OCD. i disclosed everything, including the severity of my OCD at times, but he believes ADD is the underlying cause.he's prescribed Ritalin LA 30mg. i don't have a tonne of faith in it not setting me on edge and resurrecting my OCD (which has been dormant lately), though i'll give it a shot. i wonder if i could get away with Memantine + Ritalin or if i'll have to add an SSRI to the equation. anyway, it's a relief to finally have a more rounded diagnosis, and at least if i meet with future psychs it opens up the possibility of trying stuff like Dex, etc.
Posted by g_g_g_unit on November 19, 2009, at 21:29:47
In reply to Re: calling all armchair psychs » g_g_g_unit, posted by Phidippus on November 15, 2009, at 1:50:54
Phidippus, did you ever try Ritalin for OCD?
also, if you don't mind my asking, what stopped you taking Dexedrine as monotherapy for ADHD and OCD? did you find it just wasn't enough relief, hence the addition of an SSRI?
to be honest, i am very scared of Ritalin. low-dose Parnate almost had me in tears w/r/t anxiety. i think i need a competent psych to deal with this.
Posted by conundrum on November 20, 2009, at 6:35:38
In reply to Re: calling all armchair psychs, posted by g_g_g_unit on November 19, 2009, at 21:29:47
Well the nice thing about ritalin is it only lasts about 6 hours and starts to work immediately. So you don't have to taper down if you start to feel bad and you don't have to take it for weeks to know if its helping or exacerbating your OCD. It might be worth a shot to see if it helps.
Posted by Phidippus on November 20, 2009, at 13:34:09
In reply to Re: calling all armchair psychs, posted by g_g_g_unit on November 19, 2009, at 21:29:47
> Phidippus, did you ever try Ritalin for OCD?
I did try Ritalin and it made my OCD severe.
> also, if you don't mind my asking, what stopped you taking Dexedrine as monotherapy for ADHD and OCD?
My ADHD is very mild/not really confirmed and I never did dextroamphetamine monotherapy. I always did dex with an SSRI.
P
Posted by g_g_g_unit on November 20, 2009, at 19:12:59
In reply to Re: calling all armchair psychs » g_g_g_unit, posted by conundrum on November 20, 2009, at 6:35:38
> Well the nice thing about ritalin is it only lasts about 6 hours and starts to work immediately. So you don't have to taper down if you start to feel bad and you don't have to take it for weeks to know if its helping or exacerbating your OCD. It might be worth a shot to see if it helps.
yeah, but does it change in character over time, i.e. become less anxiety-inducing once tolerance sets in?
or if it's having a negative effect on my OCD from the get-go, can i be certain it's not worth sticking with?
i picked up my script today, so will give it a shot tomorrow
Posted by conundrum on November 21, 2009, at 14:58:22
In reply to Re: calling all armchair psychs, posted by g_g_g_unit on November 20, 2009, at 19:12:59
I dunno, but you'll find out ;-)
Posted by g_g_g_unit on November 21, 2009, at 18:32:52
In reply to Re: calling all armchair psychs » g_g_g_unit, posted by conundrum on November 21, 2009, at 14:58:22
today's my first day on ritalin. i just feel foggy and high, which beats just feeling foggy i guess :)
does anyone know if Ritalin or the other amps act on specific dopamine receptors, or do they just broadly inhibit the reuptake of dopamine?
Posted by Phidippus on November 22, 2009, at 13:51:22
In reply to Re: calling all armchair psychs, posted by g_g_g_unit on November 21, 2009, at 18:32:52
its chemical structure is more closely related to cocaine. amphetamine works as a dopamine transport substrate where as methylphenidate works as a dopamine transport blocker.
Methylphenidate has both DAT and NET binding affinity, with the dextromethylphenidate enantiomers displaying a prominent affinity for the norepinephrine transporter. Both the dextro- and levorotary enantiomers displayed receptor affinity for the serotonergic 5HT1A and 5HT2B subtypes, though direct binding to the serotonin transporter was not observed.
Posted by g_g_g_unit on November 22, 2009, at 14:38:20
In reply to Re: calling all armchair psychs, posted by Phidippus on November 22, 2009, at 13:51:22
thanks. first day of Ritalin turned out to be a washout - on the one hand, it gives me the mental energy to break from compulsions and redirect my attention to more rewarding activities. but it also makes me more angsty, and the comedown is hellish. i don't envision myself sticking with it for the long haul. maybe the effect would also be more positive if i weren't depressed.
Posted by mtdewcmu on November 26, 2009, at 1:01:23
In reply to calling all armchair psychs, posted by g_g_g_unit on November 8, 2009, at 4:26:41
> i was wondering if anyone could offer any ideas for treatment based not only on my present dx, but also my med history, which i believe has had some effect on things. i would really appreciate any advice. i don't want to take another step, and make more of a mess, until i can meet a competent psychopharmacologist. but until then, if anyone has the time to consider this history i would be so grateful. i apologise for its length, but i feel like i need to be detailed.
>
> my last pdoc was not that helpful - he described my depression as a case of depleted neurotransmitters?? from what i can gather through general readings, it sounds like double depression, i.e. major depression superimposed over chronic dysthymia.
>
> so, *prior* to treatment - dysthymia, OCD, with a lot of impulsive/addictive tendencies (curious if these are just a coping mechanism, or suggest some other kind of dysfunction), as well as what someone described as emotional lability (i.e. become happy when hopeful or something 'good' happens, angry/frustrated when under stress). i was working as a writer prior to depression, hence the references to writing (this is pulled from a file i'm making up).
>
> been on:
>
> Moclobemide (300mg) by GP. Stayed on for 6 months.
>
> Pros: good anti-anxiety agent
>
> Cons: felt more dulled, slight cognitive sfx.
>
>
> Psychiatrist #1:
>
> Prozac (10mg) for 4 days
>
> Felt more alert and activated, but in a way that precluded pleasure/euphoria. Disturbed sleep, so was advised to discontinue, as due to long half-life, this side-effect supposedly would not go away??
>
> Pros: activating
>
> Cons: insomnia
>
>
> Mirtazapine (15-30mg) for 3 weeks.
>
> Slept well, but felt irritable and sedated the next day. Cognitively fine writing done in this period has a rare lucidity to it but could not stand sedation. Moved dose to 30mg, as heard higher doses were more activating. Terrible exacerbation of OCD symptoms placed in constant state of panic for a week, compounded by fact that family had gone away for Christmas vacation. Eventually pulled myself off drug without taper. Woke up in terrible foggy state suddenly found I was having problems with writing, i.e. paragraphs became much shorter and newspaper-like, could not really think things through in the same way. Complained to psychiatrist, who said it was a symptom of depression?? don't believe so, at that point.
>
> Try Prozac (10mg) again.
>
> Seems to instantly fix fogginess (don't both this and remeron work on prefrontal cortex?), but again insomnia an issue, so advised to withdraw.
>
> ^^^^^^^ it's this is what's bugging me .. whether Remeron just kind of blew out/overloaded some section of my brain which i now need to target??
>
> Try Lexapro (10mg) for 8 weeks.
>
> Experience unpleasant sense of disconnection ruminations still present, but volume turned down. Worsens ability to think clearly, enhancing earlier fog from Remeron fallout. Socially dulled, exacerbating shyness. Withdraw.
>
> Try Luvox (100mg) for 8 weeks.
>
> Experience intense, unbearable restless leg syndrome during the day (or is it akathisia?) could literally not sit down for more than 20 minutes at a time due to pressure in legs. Again feeling of disconnection experiences feel less real, when listening to music/watching movie, a lot of it just does not seem to register. Worsened mood crying because I felt so withdrawn. Could not stand restlessness, and finally discontinued.
>
> After coming off Luvox, begin to notice problems with executive function:
>
> Whereas before, I could maintain an inner monologue amidst all the clutter and obsessive thinking, i.e. think through a certain theoretical point, despite it taking me longer than Id like, now it felt like my thoughts were getting cut off prematurely I could simply not follow them to their conclusions.
>
> When writing, I lost my sense of rhythm to an extent, making any sentences that werent completely automatic (i.e. sentences I would construct in the past using my working memory as a kind of placeholder) now completely awkward and clunky.
>
> Could not concentrate on tasks at hand would just constantly seek distractions on the internet while trying to write.
>
> Completed one last piece in this state, and then finally broke down into a schizoid-like depression complete anhedonia, difficulty communicating with others, difficulty concentrating, but strangely no physical anxiety.
>
> Become desperate and try Nardil (3 months):
>
> Became (i guess?) hypomanic and far more compulsive, e.g. up exercising everyday at 7/8am after no sleep because i was worried about the weight gain. Seemed to make anxiety and OCD worse at higher doses (guess this might be transient, and due to sleep loss?). could not tolerate hypotension - fainted a couple of times at higher doses. came off.
>
> pros: helped depression
>
> cons: felt foggy, euphoric, 'not like myself'
>
> return of 'schizoid' depression. somewhat pleasant in that i am anxiety-free, but suffer from complete inattentiveness, brain fog, etc.
>
> try Memantine (20mg max, 6 weeks).
>
> at 5mg, experience slight hypomania (rushing thoughts, far greater mental energy .. almost too much), though this is obviously a relief from depression. drug too inconsistent in effects (long-half life??), and varied day to day, but there were points at higher doses where for the first time i felt completely rational, in command, and certain about my decisions (anti-OCD effect??). memory improves at certain doses. can concentrate and read again. but eventually much noted fogginess/depersonalization sets in.
>
> desperate again, so try Parnate with psychiatrist #2
>
> Parnate (max dose reached 40mg, 10 weeks)
>
> low doses help with attention problems, but increase anxiety, especially at night when stimulation wears off. higher doses cause intractable insomnia which psych offers no longterm plan to treat outside of benzos; will not raise dose either. cannot stand sleep deprivation and taper off.
>
> -------------------------------------------------
>
> so there you have it. thanks to anyone who read that, and sorry if it's a little messy.
>
> i find it interesting that:
>
> a) prozac instantly relieved my brain fog at first (so need prefrontal cortex help?)
>
> b) that memantine occasionally had me feeling completely calm and rational (mood stabilizer might help?)
>
> c) that low dose Parnate helps kind of 'pin' my attention to external things more, which, while increasing ocd/anxiety, also helps me function better. so maybe in my own layman's, drug-naive terms, increasing DA while minimizng NE might help? hence my interest in the atypicals...
>
> sorry again this is so rambly. please feel free to ask any questions.Here's what I would do if I were you:
I would go back on Lexapro, increasing to 20mg as tolerated, and I would add Wellbutrin XL, starting at 150 and going to 300.
The detached feeling from Lexapro sounds like something that may subside eventually. The Wellbutrin will counter some of the fogginess as well.
Alternately, you could try Zoloft or Effexor/Pristiq. Each SSRI is qualitatively a little different, and I don't see anything in your history to indicate that you are unable to tolerate SSRIs.
Don't make things too complicated.
Posted by mtdewcmu on November 26, 2009, at 1:20:18
In reply to Re: calling all armchair psychs » Phidippus, posted by g_g_g_unit on November 22, 2009, at 14:38:20
> thanks. first day of Ritalin turned out to be a washout - on the one hand, it gives me the mental energy to break from compulsions and redirect my attention to more rewarding activities. but it also makes me more angsty, and the comedown is hellish. i don't envision myself sticking with it for the long haul. maybe the effect would also be more positive if i weren't depressed.
Reading along with this thread, I knew you weren't going to like Ritalin. I think your attention problems are caused by anxiety, rather than the other way around. I have the same issues (except I lean more toward GAD than OCD). Your next move should be to pick one of the best antidepressants (Lexapro, Zoloft, Celexa, Effexor) and make sure you get to a sufficient dose. That means 20mg Lexapro, 100-150mg Zoloft, 40mg Celexa, or 150mg Effexor.
Posted by g_g_g_unit on November 26, 2009, at 4:06:02
In reply to Re: calling all armchair psychs, posted by mtdewcmu on November 26, 2009, at 1:20:18
>
> Reading along with this thread, I knew you weren't going to like Ritalin. I think your attention problems are caused by anxiety, rather than the other way around. I have the same issues (except I lean more toward GAD than OCD). Your next move should be to pick one of the best antidepressants (Lexapro, Zoloft, Celexa, Effexor) and make sure you get to a sufficient dose. That means 20mg Lexapro, 100-150mg Zoloft, 40mg Celexa, or 150mg Effexor.
>thanks for your advice. the only reason i tried Ritalin was so that i could have a chance to try Dexedrine (which as far as i know has studies backing its use in both OCD and GAD).
i really don't think an SSRI alone is the whole answer at this point, unless i'm basically willing to just cut my losses. SSRI's make me feel schizoid, amplify my social anxiety, and really make writing (what i was doing professionally) a difficult task. i understand it's the only real appointed treatment for my "condition", but i wish i had made more considered decisions about medication management (easy to say now i guess); i've finally accepted that i have an impulse (even addiction) problem, which has come to encompass meds (though never narcotics).
i don't think anxiety is the (whole) source of my concentration difficulties at present. i feel like i have no working memory - like my mind is just always blank, to the point where it's hard to even put a thought together. Low-dose memantine (a D2 agonist) felt like someone had turned a light-switch on in there; Bacopa (an acetylcholine agonist?) enrichened my inner dialogue to the point where i could 'hear' myself thinking again.
the only way i feel i'll overcome my depression is if i can return to writing, and i realise that, for me, most 'cures' are worse than the disease in that respect. i guess if i had chosen any other path in life, i might've been okay, but SSRI's just always dampened by creative drive and the 'buzz' i got off working, which is why i was so conflicted about staying on them. i also think SSRI's suck when it comes to treating dysthymia.
i'm intensely committed to CBT at the moment (i never really invested much energy into it in the past), and am focusing on that while i think about what to do next med-wise. i would really just like to take the simplest approach possible. zoloft sounds appealing because at least it has the modest DRI feature. maybe i should try that in combination with Memantine.
i hope i don't sound stubborn, and possibly even insensitive by complaining in this respect. i often feel a "just take your medicine and shutup" vibe from doctors. what i would like is one who cares as much about my individual needs than just trying to treat me based on the DSM
Posted by mtdewcmu on November 26, 2009, at 11:05:59
In reply to Re: calling all armchair psychs, posted by g_g_g_unit on November 26, 2009, at 4:06:02
> >
> > Reading along with this thread, I knew you weren't going to like Ritalin. I think your attention problems are caused by anxiety, rather than the other way around. I have the same issues (except I lean more toward GAD than OCD). Your next move should be to pick one of the best antidepressants (Lexapro, Zoloft, Celexa, Effexor) and make sure you get to a sufficient dose. That means 20mg Lexapro, 100-150mg Zoloft, 40mg Celexa, or 150mg Effexor.
> >
>
> thanks for your advice. the only reason i tried Ritalin was so that i could have a chance to try Dexedrine (which as far as i know has studies backing its use in both OCD and GAD).
>
> i really don't think an SSRI alone is the whole answer at this point, unless i'm basically willing to just cut my losses. SSRI's make me feel schizoid, amplify my social anxiety, and really make writing (what i was doing professionally) a difficult task. i understand it's the only real appointed treatment for my "condition", but i wish i had made more considered decisions about medication management (easy to say now i guess); i've finally accepted that i have an impulse (even addiction) problem, which has come to encompass meds (though never narcotics).
>You have not given Lexapro a chance at 20mg. Although 10mg may work for some people, for others it will produce only side effects while being too low to provide benefits. Moreover, the side effects you described sounded (to me) mild, and they are likely to respond to adding Wellbutrin. However, if your experience on Lexapro was really that bad -- and only you can know that -- you can still just try a different serotonin reuptake inhibitor, such as Zoloft.
> i don't think anxiety is the (whole) source of my concentration difficulties at present. i feel like i have no working memory - like my mind is just always blank, to the point where it's hard to even put a thought together. Low-dose memantine (a D2 agonist) felt like someone had turned a light-switch on in there; Bacopa (an acetylcholine agonist?) enrichened my inner dialogue to the point where i could 'hear' myself thinking again.
>It's interesting that you found improvement from memantine and Bacopa, but it's difficult to say what that actually means. Psychiatry is not scientific enough at this point.
Please bear in mind that depression can cause terrible cognitive problems. Personally, I thought my brain was damaged and I would never recover. I tried ADD meds such as Adderall, Strattera, and Ritalin, but antidepressants have been by far the most helpful.
> the only way i feel i'll overcome my depression is if i can return to writing, and i realise that, for me, most 'cures' are worse than the disease in that respect. i guess if i had chosen any other path in life, i might've been okay, but SSRI's just always dampened by creative drive and the 'buzz' i got off working, which is why i was so conflicted about staying on them. i also think SSRI's suck when it comes to treating dysthymia.
>Only you can decide whether the cure is better or worse than your unmedicated life. I fully encourage you to try nonmedicinal options, like CBT, if you want.
> i'm intensely committed to CBT at the moment (i never really invested much energy into it in the past), and am focusing on that while i think about what to do next med-wise. i would really just like to take the simplest approach possible. zoloft sounds appealing because at least it has the modest DRI feature. maybe i should try that in combination with Memantine.
>
> i hope i don't sound stubborn, and possibly even insensitive by complaining in this respect. i often feel a "just take your medicine and shutup" vibe from doctors. what i would like is one who cares as much about my individual needs than just trying to treat me based on the DSM
>I do not want you to "shutup." I just think you are doing things the wrong way around by trying exotic medications before you have given the simple ones a decent chance to work. It is a symptom of depression to imagine that your illness is unique and will never respond to treatments that have worked for others. I have been there.
It's true that you have tried normal antidepressants, but you tried the SSRIs at such low doses that you may have missed the potential benefits. I went through a fuzzy period with increased anxiety when starting Celexa, but I stuck with it and ended up taking it successfully for several years. Your ability to write may go away temporarily, but return after the side effects diminish. I went through a similar thing with my ability to enjoy reading during my recent 3 months of med trials.
Posted by conundrum on November 26, 2009, at 13:21:25
In reply to Re: calling all armchair psychs, posted by mtdewcmu on November 26, 2009, at 11:05:59
Interesting response. I too have had times, and still do where I feel my problem, which is anhedonia with some cognitive impairment would be untreatable. For awhile I imagined I had other underlying physical ailments like thyroid, hyperthyroid, and digestive problems, but all my tests came back normal. Now I try to put as much faith as possible in my doctor. I think its important to know your specialist is an expert in the area in which you need help. I found my pdoc from an patent application he wrote for the treatment of SSRI induced anhedonia. I feel much more comfortable now just following his directions because I know he has treated this before with success.
Sometimes I think sites like this which have a lot of people who are treatment resistant can make it seem like you will never get better, but you have to know that millions of people do respond to drugs and the people who post on a site like this are only the tiny minority of medicated population.
Posted by mtdewcmu on November 26, 2009, at 17:30:29
In reply to Re: calling all armchair psychs » mtdewcmu, posted by conundrum on November 26, 2009, at 13:21:25
> Interesting response. I too have had times, and still do where I feel my problem, which is anhedonia with some cognitive impairment would be untreatable. For awhile I imagined I had other underlying physical ailments like thyroid, hyperthyroid, and digestive problems, but all my tests came back normal. Now I try to put as much faith as possible in my doctor. I think its important to know your specialist is an expert in the area in which you need help. I found my pdoc from an patent application he wrote for the treatment of SSRI induced anhedonia. I feel much more comfortable now just following his directions because I know he has treated this before with success.
>What you are having are symptoms of depression. It could be that they were somehow triggered by the medication, but it appears more likely that you are actually under-treated.
> Sometimes I think sites like this which have a lot of people who are treatment resistant can make it seem like you will never get better, but you have to know that millions of people do respond to drugs and the people who post on a site like this are only the tiny minority of medicated population.
>
>This board definitely has a very strong bias. Many of the posters, as you said, have TRD, and have worked their way through the pharmacopia and are down to the most exotic and/or cutting edge medications. I think this can cause a person with normal depression who stumbles across this board to over-analyze and miss the obvious solutions. You would hope that their doctors would steer them straight, but obviously in some cases this does not happen.
Posted by g_g_g_unit on November 26, 2009, at 21:53:47
In reply to Re: calling all armchair psychs, posted by mtdewcmu on November 26, 2009, at 17:30:29
maybe treatment resistant doesn't always necessarily mean the person is incapable of 'remission', but that the person struggles to find a med that"s conducive to their lifestyle.
i guess you might say in that case the person is being fussy, or hardheaded, or simply hasn't endured enough suffering to abandon their standards. maybe for me my doctor 'steering in me in the right direction' would've meant pushing CBT as a frontline measure, since i suffered primarily from anxiety, rather than going straight to meds.
you also can't tell me with certainty that SSRI's will bring back my writing panache - for one, there's more than enough collective personal accounts that they cause word-finding difficulties (which i've experienced on meds), induce apathy/anhedonia over time, etc. i don't mean to sound like a blind dissenter, and i'm happy they worked for you; it's just probably best to keep an open mind about both sides of the med argument.
of course you reach a point where you have no other choice, which i guess i'm nearing, but i'm not suffering from the illusion that i'll ever get back to where i was. i really don't think it's a symptom of depression either - meds can probably help bring me back to a kind of healthy baseline, and also foster an indifference about my plight, but i have no doubt that they can mess with certain facets of your personality/cognition.
at that point it becomes a kind of existential/psychotherapy issue of reorientating yourself to deal with your new state; but i know that anxiety has always been a driving force for me, for better and ultimately worse, and i'm happy as heck that i held out on being medicated before i had a chance to really lay down the blueprint of my career and who i am.
Posted by mtdewcmu on November 26, 2009, at 23:42:40
In reply to Re: calling all armchair psychs, posted by g_g_g_unit on November 26, 2009, at 21:53:47
Whatever you end up doing, keep us posted.
Posted by g_g_g_unit on November 27, 2009, at 1:09:53
In reply to Re: calling all armchair psychs, posted by mtdewcmu on November 26, 2009, at 23:42:40
thanks for your support, and i hope i didn't sound too defensive. i'm thinking of maybe just trying to go back on Moclobemide at a higher dose than last time, and combining it with low dose memantine. a little exotic, maybe, but moclobemide works fast for me, was pretty neutral cognition wise, and had a great anxiolytic effect. once i'm more stable mood/anxiety-wise, then i could see if there's any residual attention problems i need to deal with.
This is the end of the thread.
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