![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by emme on October 28, 2005, at 20:08:20
Hi Scott,
I've lost track. Your trial of dexamethasone is done, right? What are your impressions? How are you doing?
em
Posted by SLS on October 29, 2005, at 2:26:32
In reply to SLS - how's the trial?, posted by emme on October 28, 2005, at 20:08:20
Hi Emme.
> I've lost track.
Me too.
:-)
> Your trial of dexamethasone is done, right?Correct.
> What are your impressions?
I feel nothing positive.
I am still hoping that there is some latency of effect that will kick in at some point post-discontinuation. It has been three days. I did experience a heck of an energy drain 36 hours after my last dose.
Given my high cortisol levels, bipolar diathesis, and failure to respond to dexamethasone, the question becomes, how would someone with low cortisol and an atypical unipolar diathesis respond to it?
> How are you doing?
Crappy, but not terrible.
Do you think the memantine is still helping you? When was the last time you attempted to increase the dosage to verify that it still had some therapeutic "punch" left in it? I know you are taking a low dosage because of issues involving intolerance to side effects. However, I am curious if you still feel more of an antidepressant effect at the higher dosages, despite your intolerance.
It looks like mifepristone will be my next stop. I won't be able to start it until after Thanksgiving, but I guess I can wait.
- Scott
Posted by emme on October 29, 2005, at 7:47:34
In reply to Re: SLS - how's the trial? » emme, posted by SLS on October 29, 2005, at 2:26:32
> Hi Emme.
>
> > I've lost track.
> Me too.I think I have a secondary diagnosis of nobrainatall.
> > What are your impressions?
> I feel nothing positive.Rats.
> I am still hoping that there is some latency of effect that will kick in at some point post-discontinuation. It has been three days. I did experience a heck of an energy drain 36 hours after my last dose.I hope so.
> Given my high cortisol levelsHave you tried ketaconazole or any other cortisol-lowering drugs?
> how would someone with low cortisol and an atypical unipolar diathesis respond to it?
I spoke with an endocrinologist this summer who may try to treat some of my pdoc's treatment-resistant patients with cortisol-lowering drugs. He seemed to think that there was potential for a short course of a tiny dose for people with normal cortisol levels. As I understand it, even if cortisol levels are normal, if the daily variability is not normal, then the system might benefit from being reset. We didn't get to the question of treating people who have normal totals *and* normal diurnal variability.
He hadn't yet written the protocol, but was hoping to do it by the end of summer. I've had a response to Abilify, so I haven't been in contact with him again.
> Do you think the memantine is still helping you? When was the last time you attempted to increase the dosage to verify that it still had some therapeutic "punch" left in it?
Yeah, I think it is. I had dropped it down to 1.25 mg, actually. Then put it back up. I think I am a little better at the higher dose. 2.5 mg seems to be the max I can do.
I'm trying to find some sort of workable dosing of both memantine and abilify. With abilify, the insomnia and cold intolerance are problems. The insomnia might still improve. I don't know what I can do about the cold intolerance and it's getting cold outside! I can't concentrate on anything feeling so chilly. I'd forgotten about it. Last time I tried abilify, you suggested that it might be acting in a similar manner to apomorphine. If I knew it might ease up, it would help me be more patient.
Hang in there until the mifepristone (sp?) trial.
In the meantime, I hope you get your delayed reaction to the dexamethasone.em
Posted by ravenstorm on October 29, 2005, at 11:05:10
In reply to Re: SLS - how's the trial? » SLS, posted by emme on October 29, 2005, at 7:47:34
Thats great that you are FINALLY going to get the mif. trial!!!!!!!!!!!!!
Have you tried topomax yet?
Posted by SLS on October 29, 2005, at 12:02:15
In reply to Re: SLS - how's the trial?, posted by ravenstorm on October 29, 2005, at 11:05:10
> Thats great that you are FINALLY going to get the mif. trial!!!!!!!!!!!!!
:-)
Thanks, Ravenstorm.
I think it is important for people to realize that mifepristone is a potent blocker of cortisol receptors. The acute consequence of this is that levels of cortisol skyrocket as the body attempts to maintain homeostasis by secreting excessive amounts from the adrenals. I guess the idea is to schock the HPA axis into establishing a new equilibrium. I will be excited to be able to report to others my experience with mifepristone - good or bad.
> Have you tried topomax yet?
No, but enough people report an antidepressant effect from it such that I must consider it seriously.
This is what I'm currently taking:
Parnate 80mg
nortripyline 100mg
Lamictal 150mg
Keppra 1000mg
Abilify 10mgSo, what's happening with you?
- Scott
Posted by SLS on October 29, 2005, at 13:01:27
In reply to Re: SLS - how's the trial? » SLS, posted by emme on October 29, 2005, at 7:47:34
Hi Emme.
> > Given my high cortisol levels
> Have you tried ketaconazole or any other cortisol-lowering drugs?I've discussed it with my doctor, but we had set mifepristone as the priority. Still, it would be interesting to see how ketaconazole or metyrapone would treat me. Metyrapone is a pain in the neck to get in the U.S. It is used only to help diagnose Cushings Disease and other hypercortisolemic conditions and is dispensed only as a test agent. Novartis has a protocol set up to provide it for various treatments, but I don't know how involved the process is. Elsewhere in the world, metyrapone is available as a treatment for Cushings and similar syndromes. It might be quicker to get it from the U.K. than to bother with Novartis.
> > how would someone with low cortisol and an atypical unipolar diathesis respond to it?
> I spoke with an endocrinologist this summer who may try to treat some of my pdoc's treatment-resistant patients with cortisol-lowering drugs.Do you know which ones? Would he be combining different drugs?
> He hadn't yet written the protocol, but was hoping to do it by the end of summer. I've had a response to Abilify, so I haven't been in contact with him again.
How well are you doing with the Abilify? Are you currently satisfied with the degree of antidepressant response?
> I'm trying to find some sort of workable dosing of both memantine and abilify. With abilify, the insomnia and cold intolerance are problems. The insomnia might still improve. I don't know what I can do about the cold intolerance and it's getting cold outside!How long have you been on Abilify? Are you taking at least 5.0mg?
> I can't concentrate on anything feeling so chilly.
I have had this happen a number of times when first starting Parnate or after adding a tricyclic.
> Last time I tried abilify, you suggested that it might be acting in a similar manner to apomorphine.
If for some stupid reason, I were right, it might indicate that you need to increase the dosage of Abilify, not lower it. It depends on whether or not there is a pronounced preference for its acting as a presynaptic DA agonist at low dosages.
No answers, just more questions...
- Scott
Posted by emme on October 30, 2005, at 21:41:02
In reply to Re: SLS - how's the trial? » emme, posted by SLS on October 29, 2005, at 13:01:27
Hi Scott,
> I've discussed it with my doctor, but we had set > mifepristone as the priority.
My pdoc was interested in the idea of trying mifepristone, but hasn't pursued it aggressively at the moment. She did contact colleagues in Canada who have some experience with it. For now, she seems to have decided to work with a local endo and other cortisol drugs.
> Still, it would be interesting to see how
> ketaconazole or metyrapone would treat me.Would they be worth trying if mifepristone doesn't work? Or would they be weaker agents in comparison to mifepristone? Here's hoping you won't need to ask that question!
> > I spoke with an endocrinologist this summer who may try to treat some of my pdoc's treatment-resistant patients with cortisol-lowering drugs.
>
> Do you know which ones? Would he be combining different drugs?As far as I could tell, he was thinking of small doses of one drug. I think ketoconazole was a possibility.
> How well are you doing with the Abilify? Are you currently satisfied with the degree of antidepressant response?
I was blown away at first. Actually, I was too stimulated and felt hypomanic. Then I stopped being blown away. I think one thing that's happened is that the drugs we've tried to deal with the awful insomnia may have worsened my mood. I've had some nasty setbacks. My guess is that the AD effect of abilify is still there but was counteracted for a while.
So the current status is that I think both the memantine and abilify are good, but as usual, I'm limited by tolerance issues.
> How long have you been on Abilify? Are you taking at least 5.0mg?
No. 2.5 mg every other day. I'm reluctant to increase it until the insomnia is improved enough and I'm sure I won't be completely overstimulated. Actually, on a practical note, I may find it hard to afford a higher dose.
> I have had this happen a number of times when first starting Parnate or after adding a tricyclic.
Celexa did that to me even at 2 mg. It was ridiculous. I wonder how many people are frozen by their meds.
> > Last time I tried abilify, you suggested that it might be acting in a similar manner to apomorphine.
>
> If for some stupid reason, I were right,Hey, you never know. :) Someone's gotta be right - it might as well be you.
> it might indicate that you need to increase the dosage of Abilify, not lower it. It depends on whether or not there is a pronounced preference for its acting as a presynaptic DA agonist at low dosages.
In that case, it would be interesting to see what happens if I do try a higher dose.
> No answers, just more questions...But good questions. Thanks for the input. Keep us posted about the post-dexamethasone results.
emme
Posted by emme on October 31, 2005, at 5:31:50
In reply to Re: SLS - how's the trial? » emme, posted by SLS on October 29, 2005, at 13:01:27
It's Monday now. Anything positive happening yet from the dex.....?
Posted by SLS on October 31, 2005, at 7:01:33
In reply to P.S. » SLS, posted by emme on October 31, 2005, at 5:31:50
> It's Monday now. Anything positive happening yet from the dex.....?
Emme,
You are such a sweetie.
Nothing. Zero.
:-(
Yesterday was a bad day for me. I think the dexamethasone hurt more than it helped. It might take a few days for my system to settle. We'll see.
I am glad I tried the dexamethasone. It was a cheap and quick trial. I would neither encourage nor discourage someone from trying it. However, it would have been nice to have heard a few good anecdotes first.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.