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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by avid abulia on June 14, 2003, at 0:09:55
i am not doing all that well off of my AD though withdrawal is over (my body adjusts to med changes quite quickly, who knows why)... mostly, my OCD is getting a lot worse, but i am also depressed.
i react quite poorly to SSRIs (hostility and self injury/suicidal thoughts), have had positive responses to wellbutrin (only for depression), effexor (only for OCD), and higher doses of inversine (for both), but experienced seizure exacerbation. i have not tried TCAs or MAOIs as of yet, nor have i tried serzone or remeron. the typical and atypical antipsychotics and i are no match made in heaven. i am a cyp 450 3a4 poor metabolizer as well. my current meds are lamictal 200mg b.i.d. keppra 1000mg b.i.d. inversine 2.5mg b.i.d. and diazepam prn (generally 1.25-2.5 mg and quite rarely up to 10mg qhs-b.i.d. for tics, anxiety, insomnia, seizures or migraine--a real all-arounder for me) and parenteral morphine/phenergan/toradol, 15/25/60mg respectively prn (generally once or twice per month or two for severe basilar migraine).
does anyone know a drug or drug combo or a change that may be useful that may help with depression and OCD with a relatively low risk of seizure, tic, and migraine exacerbation?
~AA
Posted by ace on June 14, 2003, at 1:43:03
In reply to can anyone help with this?, posted by avid abulia on June 14, 2003, at 0:09:55
> i am not doing all that well off of my AD though withdrawal is over (my body adjusts to med changes quite quickly, who knows why)... mostly, my OCD is getting a lot worse, but i am also depressed.
>
> i react quite poorly to SSRIs (hostility and self injury/suicidal thoughts), have had positive responses to wellbutrin (only for depression), effexor (only for OCD), and higher doses of inversine (for both), but experienced seizure exacerbation. i have not tried TCAs or MAOIs as of yet, nor have i tried serzone or remeron. the typical and atypical antipsychotics and i are no match made in heaven. i am a cyp 450 3a4 poor metabolizer as well. my current meds are lamictal 200mg b.i.d. keppra 1000mg b.i.d. inversine 2.5mg b.i.d. and diazepam prn (generally 1.25-2.5 mg and quite rarely up to 10mg qhs-b.i.d. for tics, anxiety, insomnia, seizures or migraine--a real all-arounder for me) and parenteral morphine/phenergan/toradol, 15/25/60mg respectively prn (generally once or twice per month or two for severe basilar migraine).
>
> does anyone know a drug or drug combo or a change that may be useful that may help with depression and OCD with a relatively low risk of seizure, tic, and migraine exacerbation?Yes! An MAOI (Nardil or Parnate - I'd go Nardil first) Anafranil low dose (due to its problems with seizures). Have you tried Zyprexa or any old typical APs? Any luck?
But not just from my experience, but from the many, many, many anecdotes I've read I would say give Nardil a try. More thought but I'm about to be kicked out of my library (closing time!)
All the best,
Ace.> ~AA
Posted by Ritch on June 14, 2003, at 10:43:21
In reply to can anyone help with this?, posted by avid abulia on June 14, 2003, at 0:09:55
> i am not doing all that well off of my AD though withdrawal is over (my body adjusts to med changes quite quickly, who knows why)... mostly, my OCD is getting a lot worse, but i am also depressed.
>
> i react quite poorly to SSRIs (hostility and self injury/suicidal thoughts), have had positive responses to wellbutrin (only for depression), effexor (only for OCD), and higher doses of inversine (for both), but experienced seizure exacerbation. i have not tried TCAs or MAOIs as of yet, nor have i tried serzone or remeron. the typical and atypical antipsychotics and i are no match made in heaven. i am a cyp 450 3a4 poor metabolizer as well. my current meds are lamictal 200mg b.i.d. keppra 1000mg b.i.d. inversine 2.5mg b.i.d. and diazepam prn (generally 1.25-2.5 mg and quite rarely up to 10mg qhs-b.i.d. for tics, anxiety, insomnia, seizures or migraine--a real all-arounder for me) and parenteral morphine/phenergan/toradol, 15/25/60mg respectively prn (generally once or twice per month or two for severe basilar migraine).
>
> does anyone know a drug or drug combo or a change that may be useful that may help with depression and OCD with a relatively low risk of seizure, tic, and migraine exacerbation?
>
> ~AAIf you find out that Keppra is causing your restlessness, you might consider swapping it out for Neurontin instead.
Posted by avid abulia on June 14, 2003, at 11:17:17
In reply to Re: can anyone help with this? » avid abulia, posted by Ritch on June 14, 2003, at 10:43:21
tried neurontin--i am convinced someone managed to patent a placebo on that one... i was up to 5 grams/day and it felt like tylenol except not as good at pain relief.
Posted by avid abulia on June 14, 2003, at 11:41:37
In reply to Re: can anyone help with this? » avid abulia, posted by ace on June 14, 2003, at 1:43:03
> Yes! An MAOI (Nardil or Parnate - I'd go Nardil first) Anafranil low dose (due to its problems with seizures).
i forgot anafranil is a TCA; yes, i did try that one, and at least unlike the new-school SSRIs, it just didn`t do all that much besides making me sleep about 16 hours each day (i was fine at night anyway, though). nardil is one i`d like to give a try, as one of its metabolites is a gaba-transanimase inhibitor so it may potentially reduce seizure risk. i`ve heard that combining low-dose nardil and low-dose elavil qhs at bedtime was safe-ish and effective for all aforementioned problems except seizure disorder, and the elavil reduced risk of hypertensive crisis because it blocks calcium channels and is a noradrenaline reuptake inhibitor so it reduces vascular response to tyramine, but i don`t know the seizure risk for elavil. i`d like to give it a try, but i have to convince my p-doc... and actually, nardil was the AD my epileptoligist mentioned would be okay, and the neurologist treating my migraines seemed to think elavil would be safe but wanted to give keppra a try first.
>Have you tried Zyprexa or any old typical APs? Any luck?
yeah--i had luck alright, and it was the real bad kind.
> But not just from my experience, but from the many, many, many anecdotes I've read I would say give Nardil a try. More thought but I'm about to be kicked out of my library (closing time!)
> All the best,
> Ace.thanks for the thoughts! i`ve heard other places a lot of people who are refractory to other meds do very well on MAOIs, and i would really like to at least give it a try.
~AA
Posted by collegeadhdlil on June 16, 2003, at 0:42:12
In reply to Re: can anyone help with this? » avid abulia » ace, posted by avid abulia on June 14, 2003, at 11:41:37
i know this is kind of way out there, but i am allergic to a lot of meds and have had a lot of problems with migraines etc - and my docs put me on topamax with a couple other migraine drugs and that seemed to be the key - so maybe adding that to the equation might help.
Posted by avid abulia on June 16, 2003, at 15:14:32
In reply to Re: can anyone help with this?, posted by collegeadhdlil on June 16, 2003, at 0:42:12
> i know this is kind of way out there, but i am allergic to a lot of meds and have had a lot of problems with migraines etc - and my docs put me on topamax with a couple other migraine drugs and that seemed to be the key - so maybe adding that to the equation might help.
yeah, dopeymax was pretty rad cuz it made me lose about ten pounds, except then my BMI was below 15 and they made me do Total Parenteral Nutrition... that, and it put me in a state bordering on the far side of idiocy.what were the other migraine drugs, might i ask?
~AA
Posted by collegeadhdlil on June 16, 2003, at 20:25:13
In reply to Re: can anyone help with this? » collegeadhdlil, posted by avid abulia on June 16, 2003, at 15:14:32
well they had me on nortryptelline before i developed an allergy to it - and thats an antidepressant. Imitrex shots are okay. They kind of didnt figure out where my headaches were coming from until recently - even with the mris, lumbar punctars, weeks in the hospital with treatments - because my headaches got to the point they were so bad i was going to class - getting up in the middle of class going to the bathroom and throwing up - i was in so much pain, i couldnt keep anything down. Anyway - for a while they were just making sure I took my adderall ( i take 20mg 3x a day) gave me depakote (hate the stuff) and gave me perkoset. The low tyramine diet is helpful to some extent...I dont know if theyve checked this out, but one doc found out that i had a sleeping disorder ontop of all of this an added mirapex - which i didnt like personally - but they should check your iron levels b/c muscle contractions trigger everything off - oh they had me on verapamil for a little too, but i have low blood pressure so no go - i dont know if i was any help - your description of your problem was a little over my head - i am a little more than a week before my summer school finals right now & having some problems with other meds - lol - what else is new. sleeping on a japanese buckwheat pillow is also supposed to help. The guy i went to was really great, a nice young neurologist from harvard w/o the complex...let me know if you need any more clarification or anything
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