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mikl_pls

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  • Birthday 09/11/87

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  1. That's.... odd to me... A small dose of venlafaxine only acts on serotonin. Never really heard of taking two SNRIs concomitantly unless you're cross-tapering between one to another.
  2. @amskray I think everyone has mentioned pretty much everything. The antidepressant Remeron goes well with SNRIs, but you have to watch out for sedation and weight gain. Higher doses are better as an antidepressant. I am doing well with a combo of Abilify 15 mg, Cymbalta 120 mg, Dexedrine 30 mg, plus other meds like Trileptal 1200 mg, and titrating up on Topamax (Trokendi XR). But the core I think are the Abilify, Cymbalta, and Dexedrine. I was on this combo two summers ago when a bout of anhedonia hit me like a ton of bricks. I could tell it was doing something to try to get me out of it, but that's more than I can say about anything else I tried.
  3. Same here, more anxiety plus mixed dysphoric hypomania (agitation, anxiety, dysphoria, etc.) on as little as 5 mg/day. A friend of mine, @THE_REAL_Bryan, had A LOT of sedation, apathy, and eventually agitation on as little as 5-10 mg/day. Not trying to scare you away from it, many people have good responses from it. Klonopin worked okay for me for a while, but eventually caused depression. Valium works much better for me.
  4. With Effexor, you have two mechanisms of action, SRI and NRI. The SRI will affect all serotonin receptors, but the main serotonin receptors I believe affecting mood will be 5-HT1A, 5-HT2A, and 5-HT2C. Basically speaking, increased numbers of these receptors cause anxiety and depression, and increased serotonin levels will downregulate or cause them to decrease in number. With the NRI, I believe I read (in a Google book preview, so no link available) that increased norepinephrine will cause noradrenergic receptors to decrease firing rates but not downregulate. So at 75 mg, Effexor's serotonin reuptake inhibition is pretty much maxed out--112.5 mg will not yield more SRI. But at 150 mg, you start to tap into the dual mechanism SNRI of the med, and the NRI starts to act, acting on adrenergic receptors. That's my theory anyway. But not to deviate from OP's topic.
  5. What album best describes your MI?

    Ulrich Schnauss - A Strangely Isolated Place. I listen to it when I'm super down and it somehow makes me feel that it's okay to feel that way. It makes me feel at peace with my MI.
  6. Emsam was weight neutral for me, and perhaps even promoted weight loss for me. That was just my experience. Your mileage may vary (YMMV). It just didn't work was the only problem. I experimented with 12 mg and even 15 mg and only at 15 mg did I start to get a response. So who knows what dose I would've needed? 18 mg? It has been prescribed up to 24 mg I've heard (12 mg x 2). But I digress. I personally didn't gain weight, but I have heard of some who have, but it's not common from what I've read/heard. If you are looking to give Emsam a try, I'd say go for it! It's a very innocuous medication. 6 mg isn't really effective for most people, I'll just go ahead and say that, and my pdoc said that there isn't much difference in 6 mg and 9 mg, but she refused to prescribe me 12 mg (go figure?).
  7. OMG so it wasn't just me! *sigh* Mine was definitely not fluid retention lol. It was 100% fat, and I'm still trying to lose it. Making some progress. It wasn't helped by Anafranil that I took recently.
  8. It's supposed to be worn 24/7, but I suppose some pdocs might tell their patients to take it off at a certain point in the day to avoid insomnia. My pdoc used trazodone or doxepin or something else to help with insomnia. Hey, it's not a dumb question, no need to belittle yourself. When I was on it, I always would take the old one off in the morning, take a shower, and put a fresh one on each morning on clean skin so it would stick better and I guess distribute better through the skin. I did have mild skin allergies with it, but not as bad as with the Neupro patch (totally different class of meds -- dopamine agonist).
  9. I'm so sorry you've gone through so much. It seems you and I have a lot in common. I really wanted to get ECT back in fall of 2016 but my pdoc failed to get anything set up about that. My pdoc doesn't do TMS, but does do VNS, and would've probably encouraged me to get a vagus nerve stimulator without trying ECT. I admit I'm jealous you got to try buprenorphine, ketamine, ECT, TMS, etc., but again, sorry they didn't work for you. I wish something had after all you've gone through. It seems I've read somewhere (it seems I can never produce a link though when I say anything) that low-dose clozapine can help severely treatment-resistant depressed patients. I read in a google book (no link available... sorry...) that the combination of nortriptyline and lithium during maintenance ECT was more likely to prevent relapse than just the two meds alone or maintenance ECT alone. You will definitely want to check with your pdoc about that "citation" though, especially since I can't provide the source. Mirapex has the most research behind treating depression, but Requip has also been used, and apparently Neupro too (but Neupro $$$!!!), but I'm sure you're done with dopamine agonists by now. Buspirone, at which doses specifically preferentially I don't know, supposedly has the ability to antagonize the dopamine autoreceptor, thereby inducing dopamine release. It's also a 5-HT1A partial agonist, which would theoretically induce downstream dopamine release, though it's of a lower intrinsic activity than Viibryd or Trintellix, so if neither of those worked for you, that mechanism, at least, wouldn't work for you; however, the preferential dopamine autoreceptor antagonism might be worth looking into. There are meds outside of this country that do that in low doses, namely the antipsychotics amisulpride, sulpiride, and flupenthixol (or flupentixol, however you want to spell it), but it's a shame that we don't have these meds... But I wish you the absolute best of luck in finding something that helps you out, and take care meantime!
  10. It's a tossup between anhedonia and psychosis (the latter which happens only occasionally and only when the depression is very severe). The anhedonia can be present regardless, so maybe anhedonia, but psychosis is scary as hell at times. The anhedonia is so pervasive throughout my life that all I can do is sleep some days. I find myself more like this if I allow myself to become lonely and isolated for an extended bit of time. We live pretty much in the middle of nowhere, but one of my best friends lives just up the road from me; however, he also suffers from depression, and he often isolates himself by choice when he feels depressed. So when I can't spend time with friends is also a time when I go on a down-swing, and it's recursive. I wish all the best to all of you. We all deserve happiness in our lives.
  11. This is derealization (I believe); nevertheless, it's a dissociative symptom. This could potentially be serious. You might want to get with your pdoc about this.
  12. Saw neurologist today. He wants me to come off Zonegran and then go on Tronkendi XR (hopefully the "insurance" card he gave me will pay for it, otherwise I'm screwed because of the 50% coinsurance thing). He also seemed to want to increase my Trileptal, but he said, "one thing at a time." I am to decrease Zonegran by 50 mg/week until I'm off, then start Trokendi XR 25 mg for 2 weeks, 50 mg for 2 weeks, then 100 mg and continue until June at my follow-up appointment. I have an EEG (3rd one... I told him he wouldn't find anything unless he did a 24-hour video EEG but we'll see) and MRI scheduled for seizures and tremor, respectively. As for now, here's my cocktail. Not much has changed, just dosages maybe, and a few additions here and there. Psychiatric meds: Aripiprazole (Abilify) 15 mg 1 po q AM: bipolar 2, psychosis (apparently I can have psychosis with bipolar 2 according to my pdoc?) Belviq XR (lorcaserin) 20 mg 1 po q AM: obesity Dextroamphetamine (Dexedrine) 10 mg 1 po TID (30 mg): ADHD-PI, obesity Diazepam (Valium) 2 mg 1 po TID-QID (6-8 mg): anxiety, lowered due to sedation but I'm quickly beginning to think I may need it back up to 5 mg TID again... Duloxetine (Cymbalta) 60 mg 1 po BID (120 mg): bipolar 2 depression, OCD, BED (we decided not to go with imipramine this time around) Oxcarbazepine (Trileptal) 300 mg 1 po BID (600 mg): bipolar 2, anxiety (does wonders for anxiety!!), possible seizures Rytary (carbidopa/levodopa IR/ER ) 25.75 mg/95 mg 1 po TID (77.25 mg/285 mg): for tremor, my neurologist said he may want me off of this in the near future as Trokendi XR will hopefully help with that Zonisamide (Zonegran) 350 mg (150 mg q AM + 200 mg QHS): bipolar 2, possible seizures; as stated above, this will change weekly Loxapine (Loxitane) 5 mg 1 po QD PRN: breakthrough psychosis, anxiety, Tourette's disorder Oxazepam (Serax) 15 mg 1 po BID PRN: breakthrough anxiety/panic attacks Non-psychiatric meds: Metformin (Glucophage) 500 mg 1 po BID (1000 mg): pre-diabetes, metabolic syndrome Esomeprazole (Nexium) 40 mg 1 po q PM 1h ac: GERD Levothyroxine (Synthroid) 50 mcg 1 po q AM 1h ac: hypothyroidism Montelukast (Singulair) 10 mg 1 po QHS: asthma, allergies Victoza (liraglutide) 1.8 mg SC q AM: pre-diabetes, weight loss, apparently beneficial for mood disorders Vitamin D2/Ergocalciferol (Drisdol) 1.25 mg/50000 IU: hypovitaminosis D Breo Ellipta (fluticasone furoate/vilanterol) 100 mcg/25 mcg/actuation DPI 1 puff QD: asthma, maintenance Minocycline (Minocin) 100 mg 1 po BID (200 mg): acne Metaxalone (Skelaxin) 800 mg 1 po QID PRN: back pain ProAir RespiClick (albuterol inhaled) 90 mcg/actuation DPI 2 puffs q4-6h PRN: asthma, rescue Levalbuterol (Xopenex) inhalation solution 1.25 mg/3 mL (0.042%) neb 1.25 mg NEB q6h PRN: asthma, rescue Plus misc. dermatological meds but won't go into those besides diclofenac sodium topical gel (Voltaren Gel) 1% use as needed for red ear syndrome.
  13. Once again, it was a combination of sources that I can't find the links to. :X
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