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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by okydoky on December 3, 2009, at 11:33:11
Not sure if I should have posted this on medication board but I am asking suggestions based on the ADS affect on Neurotransmitters. (at least I am attempting to)
I have been on and off this board for several years. I am unable to take most anti depressants because of a pre existing bladder disease. I have TRD along with a lot of anxiety.
I have taken a lot of Ads over the years.
Parnate used to work. (none of the other MAOs did much except Marplan)
Amineptine worked pretty well for a time.
Effexor seemed like it would have worked, and reduced my anxiety but I had too many side effects. (Duloxetine did nothing.)
Amisulpride helped a lot but my prolactin went too high.
I take perphenazine 4mg on an as needed basis but it only dumbs me down and I can only take it occasionally as I get akathisia if I take it two days in a row it does nothing to Improve my mood.
The narcotic medications I need to take, Oxycontin and Morphine definitely have a bit of an anti depressant effect.
I have been taking 20mg slow release Ritalin daily for many years which just enables me to get out of bed but lately it is not even doing that. For about three years I snorted Cocaine (only at work) and it worked very well as an AD for me like this which was one of my psychiatrists reasoning at the time for prescribing oxycontin.So the ADs that seemed to work at all were all DA reuptake inhibitors.
I have only commented on these that have had some that produced dome improvement and/or those that I have been able to take. I motioned duloxetine because of its similarity to Effexor. I have tried many many more Ads over the years that did not work and/or I could not tolerate. A few that did not work are Welbutrin, reboxetine, mirapex, several SSRIs, several tricyclics and a myriad of other drugs.At this time I can no longer tolerate Parnate, never could Effexor and had to decrease my amisulpride dose to tolerate it and then go off of it as described.
I wondered about trying Abilfy? It does not appear to make sense as it is not a DA reuptake inhibitor. I see Abilfy is a DA2 partial agonist +++ and DA3 antagonist +++ from SLS table. I read it might be good for people with pain.
I dont understand neuro. effects much. The Effexor has a DA reuptake inhibition effect as does Ritalin and cocaine. I dont understand Parnate.
I dont get out of bed, take a shower or get dressed most days for the last few months and not so much even for the last two years.
Any suggestions or comments would be greatly appreciated.
Thanks,
oky
Posted by SLS on December 3, 2009, at 13:08:48
In reply to Suggestions requested, posted by okydoky on December 3, 2009, at 11:33:11
I would suggest that you post your questions on the Medication board, too. In the meantime, I'll give your situation some thought. Just to let you know, Parnate demonstrates a slight preference for inhibiting MAO-B, the dopamine enzyme.
- Scott
Posted by okydoky on December 3, 2009, at 13:27:05
In reply to Re: Suggestions requested, posted by SLS on December 3, 2009, at 13:08:48
Thanks.
I was thinking of you as I posted this. You have helped me a lot in the past.
I also looked up all the drugs I took on your chart to inform me what to post.
oky
Posted by Alexanderfromdenmark on December 4, 2009, at 11:00:23
In reply to Re: Suggestions requested » SLS, posted by okydoky on December 3, 2009, at 13:27:05
Male or female?
Posted by okydoky on December 4, 2009, at 11:26:07
In reply to Re: Suggestions requested, posted by Alexanderfromdenmark on December 4, 2009, at 11:00:23
female
with the amisulpride the doc said it was if I was pregnant and lactating.
Hope I am not being too personal?
Are you currently in Denmark?
Posted by Alexanderfromdenmark on December 5, 2009, at 12:11:24
In reply to Re: Suggestions requested, posted by okydoky on December 4, 2009, at 11:26:07
Yes, How high was your dosage of amilsulpride something something?
Currently on it and trying to avoid high prolactin.
Posted by okydoky on December 5, 2009, at 13:23:56
In reply to Re: Suggestions requested, posted by Alexanderfromdenmark on December 5, 2009, at 12:11:24
I don't remember but I tried to go back and check the archives.
All I found that I had written was that at 75-100mg I was unable to take it because of bladder issues so I know it was less than 75mg.
I read several people were taking it at 50 or 25mg.
Check out this thread:
http://www.dr-bob.org/babble/20060429/msgs/639622.html
Good luck
Let me know how it goes,oky
Posted by okydoky on December 5, 2009, at 13:33:26
In reply to Re: Suggestions requested, posted by Alexanderfromdenmark on December 5, 2009, at 12:11:24
I forgot to mention the medications I am currently on, since I am asking for informed input:
Ritalin ER 20mg 1/day
Valium 4mg 3/day (for muscle spasm)
Morphine IR 30mg 1-2/day
Clonazepam 1mg 1-2/day as needed (generally only take a lot at a time to escape)
Benadryl (take to sleep, escape and the antihistamine helps my bladder disease)A myriad of different fibers and laxatives to enable me to continue to eatdue to complitions of an "Interstim" implant in July.
My mood gets worse when I discontinue the Morphine or the Ritalin and some days I am very anxious to the tranquilizers help some. I would be willing to go off of any of it to try something else, providing my pain level is not too bad at the time.
oky
Posted by SLS on December 5, 2009, at 13:37:07
In reply to Re: Suggestions requested forgot current meds, posted by okydoky on December 5, 2009, at 13:33:26
> I forgot to mention the medications I am currently on, since I am asking for informed input:
>
> Ritalin ER 20mg 1/day
> Valium 4mg 3/day (for muscle spasm)
> Morphine IR 30mg 1-2/day
> Clonazepam 1mg 1-2/day as needed (generally only take a lot at a time to escape)
> Benadryl (take to sleep, escape and the antihistamine helps my bladder disease)
>
> A myriad of different fibers and laxatives to enable me to continue to eatdue to complitions of an "Interstim" implant in July.
>
> My mood gets worse when I discontinue the Morphine or the Ritalin and some days I am very anxious to the tranquilizers help some. I would be willing to go off of any of it to try something else, providing my pain level is not too bad at the time.
Maybe a combination of Cymbalta and Wellbutrin?Cymbalta would be helpful for the pain, and Wellbutrin might act similarly to Ritalin.
- Scott
Posted by okydoky on December 5, 2009, at 15:17:41
In reply to Re: Suggestions requested forgot current meds » okydoky, posted by SLS on December 5, 2009, at 13:37:07
Thanks
Ive tried Cymbalta several times with no result. I also tried Wellbutrin a couple of times and had no result at all. The Wellbutrin was many years ago so I do not know how much I tried but I do remember I tried it more than once.
What do you think of Abilify or Sulpride as apposed to amisulpride?
Maybe the two together would make a difference even though alone neither helped?(wellbutrin and Cymbalta)
By the way how are you doing?
oky
Posted by SLS on December 5, 2009, at 16:38:41
In reply to Re: Suggestions requested forgot current meds » SLS, posted by okydoky on December 5, 2009, at 15:17:41
> What do you think of Abilify or Sulpride as apposed to amisulpride?
Amisulpride, unlike the other two, acts as a potent antagonist at serotonin 5-HT7 receptors. It is this property that some researchers believe makes amisulpride a better antidepressant or anti-dysthymic. I like Abilify as an augmenter of antidepressants. A friend of mine is doing better on Geodon.
I don't know what makes the best sense for you to do right now. If you did not benefit at all from Wellbutrin or Cymbalta, you might want to go a different route. You could try combining Effexor with nortriptyline. Then, if this does not work, you could then switch from Effexor to Parnate and leave the nortriptyline in place. Of course, there are other things you can do, but without any more information, it is hard to know what has not been tried yet.
Is there anything bipolar going on with you or your family?
> By the way how are you doing?
I could be worse, but I could be a lot better. I'm taking 5 drugs and am not even 50% improved. I am not happy. It really gets to me sometimes.
Currently:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 450mg
- Scott
Posted by okydoky on December 5, 2009, at 19:10:56
In reply to Re: Suggestions requested forgot current meds » okydoky, posted by SLS on December 5, 2009, at 16:38:41
Parnate is out as it does not work any more and the last time I tried it I could not take it because of my bladder disease. Effexor I cannot take at all for the same reason,it causes even more pain. I don't remember trying nortriptyline. I think by the time it came up I had given up most anything especially TCA's. I had tried Elavil and Tofranil but one I was allergic to and the other I did not stay on long enough to tell. I was only 16. Later my psychiatrist did not think it was worth trying but I have nothing to loose now.Thanks for explaining the sulpride stuff. Lamactil gave me a rash right off and Lithium did nothing for me. I really have tried almost all the antidepressants or at least one or two chemically similar. Hence looking at things not typically used as AD's. Honestly after Parnate I think the best AD I ever used was small dose cocaine all day for three years!
I remember looking at Geodon. I don't expect to feel "happy" but maybe get out of bed and take a shower every now and again. So Abilify or Geodon might not get me even close to "normal" but almost anything is better than where I am at now.
You are on a pretty high dose of Parnate. I took it for years. Towards the end at high doses. How is your sleep? Does it make you anxious? I used to pass out on Parnate and Maprlan from hypotention. In the last 3 years as its efficacy faded I used to go off of it every 3 months and onto Marplan for a while and then back on Parnate. It made it work a little longer. I was also on Moclobimide during these Parnate "vacations" but it was not very effective. (Thought the info might be helpful for you) Got me through a month or two until I went back on the Parnate. I found depakote as a good adjunct to it. But it looks like you're on more than enough.
I get some relief from taking ambien during the day.
There is a lot of depression in my family and some OCD. I've never heard anyone speak of bipolar but back in the days they probably would not have diagnosed it. My grandmother and aunt on my father's side both had ECT and one cousin has OCD very bad. I think he is in a "home".
I wish you were feeling better.
Well I did get dressed today so I need to try and take advantage of it and try and go out and buy some groceries.
Later,
oky
Posted by okydoky on December 6, 2009, at 2:41:11
In reply to Re: Suggestions requested forgot current meds » okydoky, posted by SLS on December 5, 2009, at 16:38:41
This is completely off subject but I just read a bunch of stuff on the admin board which is why I generally stay off the site unless I am looking desperately for help. No doubt there are a lot of very nice and very intelligent people here to include you, but it is so reminiscent of a real life mental health community setting where the "administrators" psychiatrist and/or directors heads barely fit through the doors and where power and self esteem is manifested through careful planned out manipulation of everyone possible around them most especially the most vulnerable ones, the people who are there because they are in need and at the mercy, because of their particular problems of the moment (too many to go into)of those who they put their trust in but many times are there mostly because of their own needs. I have been a staff member in a mental health facility. I have experienced it all from every angle to include a lawsuit against the state. I have had conversations with professionals ad nauseum about it. Once I was one of them some of the "good" ones got honest with me. There were a few times it was so bad I asked them not to tell me anymore! There are a lot of good people for sure but we are all human. Power corrupts and absolute power... It has been my experience in life not just in psychiatry that anywhere there is a vulnerable populous there will be an attraction for those that will take advantage. I need never to go to any board here but the med and neurotransmitter board.
I'm just ranting and raving. It is just so da**** sad. It is society at its worst. Isn't there something in the Bible about you can judge a society by how it treats it most vulnerable. Maybe I am remembering wrong and it is not biblical?
This is nothing new I have always felt this way for a very long time. This is just an extension of the best and the worst of society. Really bad analogy but I am tired: Like in a concentration camp. People desperately helping each other at their most vulnerable while the "administrators" manipulate some to do their bidding and punish others...
This was terrible I am never going to read another thing on the admin board, it makes me ill.
I apologise but I am still posting this as I am angry and not just this stupid admin board but like I said how this society treats its most vulnerable and I am not just speaking about people with mental health problems. What a world we live in.
Please forgive me and babbble if I am "punished" :)
oky
Posted by SLS on December 6, 2009, at 6:18:51
In reply to Ranting, posted by okydoky on December 6, 2009, at 2:41:11
I hope your rant was therapeutic. Gosh, I am really sorry to know how ill you are and how stuck you probably feel. I can empathize with you. I only wish that I had the tools to make us both well.
The Administration board can be extremely toxic. I get involved there every now and then, and it is not that often that it is a harmonious exchange. This is of my own doing, of course.
By the way, I found that combining Effexor with nortriptyline was moderately effective for me. I didn't stay with it because it just wasn't enough. I would not have been able to return to work. I might go back to it, but use a higher dosage of nortriptyline. I was only taking 75mg at the time. We subsequently discovered that I need 150mg, so I was clearly underdosed.
- Scott
Posted by conundrum on December 6, 2009, at 8:53:33
In reply to Re: Ranting » okydoky, posted by SLS on December 6, 2009, at 6:18:51
Why not try again with the higher dose?
Posted by okydoky on December 6, 2009, at 11:56:09
In reply to Re: Ranting » okydoky, posted by SLS on December 6, 2009, at 6:18:51
I was just going to apologise.
I have to thank you for responding at all yet not being so nice.
It is never really therapeutic for me. I wish it was but when my depression gets bad nothing exorcises the negativity.I'm going to take some sleeping pills and try and get some sleep because I really did not get much last night.
Thanks,oky
Posted by SLS on December 6, 2009, at 12:50:38
In reply to Re: Ranting » SLS, posted by conundrum on December 6, 2009, at 8:53:33
> Why not try again with the higher dose?
Thanks for the feedback.
I think that will be the next thing I do. For now, I would like to give things a little more time. My doctor would like to use me as a guinea pig to test out a new magnetic therapy machine he has. I am still thinking about it. I really don't have much to lose.
- Scott
Posted by okydoky on December 7, 2009, at 9:54:38
In reply to Re: Ranting » SLS, posted by okydoky on December 6, 2009, at 11:56:09
Please ignore the Babble. I was pretty messed up. What I really am trying to do is figure out what might be worth at least trying but there is such a long and convoluted history I think it would take a long time for someone to be informed enough to help me.
Thanks,
oky
ps I used ot be iris
Posted by okydoky on December 7, 2009, at 17:45:18
In reply to Re: Suggestions requested forgot current meds, posted by okydoky on December 5, 2009, at 19:10:56
Hard to remember what all I have tried and for how long and also get a straight line of thinking.
I have recently (in the past year or two) tried Cymbalta at least 3 times and it did nothing for the pain or the depression and I made sure to try it long enough and at high enough doses.
As much as I can recall I tried Wellbutrin at least once, maybe twice but long ago as an adjunct to other drugs. I tried amitriptyline 34 years ago and only for a few day and then in the past year or two but at a very low dose as it is supposed to help my I.C.
Do you think the trying the nortriptyline would be better than trying the amitriptyline again?
So for tomorrow if you get to this I am thinking of either
Wellbutrin plus amitriptyline.
Or some mix with Geodon or Abilfy?Milnacipran and Ultram and Cymbalta did nothing.
Effexor helped a lot but I cannot take it.
Parnate helped the most but it stopped helping and I cannot take it now.
Amisulpride helped quite a bit but I was still somewhat depressed.
Small dose perphenazine helps only as a tranquilizer ans I can only take it occationally because my jaw muscles clamp up.
What about Pristiq?
Which leads me to Abilfy, Geodon either as adjunct or by itself because nothing else will help at all.
I am thinking if Wellbutrin can replace the Ritalin and maybe work better it might be the way to go for now.
Also Geodon based on my good result with amisulpride as apposed to Abilify?I am not sure if I will have problems with prolactin more with Geodon than Abilify? Of course there is a good chance I will not be able to take the Geodon or at least only a small dose like I could the amisulpride but it was enough.
So these are all my ideas some based on SLS suggestion of Wellbrutrin and on my previous results with certain medicines.
Sorry if this is confusing.
Any help would be appreciated and if it is not by tomorrow I can always start one thing or wait as I have an appointment with my PCP then.
oky
Posted by okydoky on December 8, 2009, at 0:00:29
In reply to Re: Suggestions requested forgot current meds, posted by okydoky on December 7, 2009, at 17:45:18
I keep rethinking things. I am really leaning towards amisulpride because I did so well on it before on a low dose. I just wondered what anyone thought of adding Bromocriptine or Cabergoline. I would not be able to take it unless I could lower the prolactin. I saw one particular post http://www.dr-bob.org/babble/20091029/msgs/924785.html
Does anyone else have any experience with it and would it matter that I am female?oky
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