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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by tensor on January 9, 2013, at 1:37:44
Have been doing fairly well on Lamictal 100mg, Seroquel 300mg, 2mg Clonazepam and modafinil p.r.n. for seven months, taking it for depression (fatigue, low drive) and anxiety. I am working but I'm feeling my energy level's dropping, although I eat healthy and exercise six times a week.
I haven't been researching treatments for quite a while, I don't do that while in remission. So it would be nice if someone could update me if there are any new medications in the psychiatry field.Thanks.
Posted by SLS on January 9, 2013, at 2:27:19
In reply to An update, posted by tensor on January 9, 2013, at 1:37:44
Hi Tensor.
> Have been doing fairly well on Lamictal 100mg, Seroquel 300mg, 2mg Clonazepam and modafinil p.r.n. for seven months, taking it for depression (fatigue, low drive) and anxiety. I am working but I'm feeling my energy level's dropping, although I eat healthy and exercise six times a week.
> I haven't been researching treatments for quite a while, I don't do that while in remission. So it would be nice if someone could update me if there are any new medications in the psychiatry field.
>
> Thanks.What kind of exercise do you do? There is such a thing as over-training, in which case you could experience a drop in energy and motivation. I don't know about anxiety, but I imagine it is possible that it gets worse if you are under physiological stress.
New drugs? I don't think there is anything new since your last visit...
The most recent antidepressant is Viibryd (vilazodone). It is a serotonin reuptake inhibitor and serotonin 5-HT1a partial agonist.
Latuda (lurasidone), already available as an antipsychotic, will soon be approved for depression. It is a sister drug to Geodon (ziprasidone), and has 5-HT7 antagonism as an antidepressant property.
Saphris (asenapine), and antipsychotic, has an interesting pharmacological profile, including NE alpha-2 antagonism (similar to Remeron). It can be energizing.
Minocycline seems to work well for depression in some people. It is an anti-inflammatory and is also anti-glutamatergic. There is a possibility that it might work particularly well with Lamictal. Minocycline can take months to exert its full effect, although the two people I know who take it (including me) experienced an improvement during week 1.
I am having luck with prazosin. It might be particularly beneficial to people who have PTSD or a history of chronic childhood traumas (developmental PTSD). To me, it feels like an antidepressant.
NAC (N-acetylcysteine), a food supplement, is still being promoted by the NIMH and people at Harvard for treating depression. I had a bad reaction to it. It made my depression moderately worse. NAC can take 3 months or more to work. It is a precursor to a powerful antioxidant, glutathione, and has a suppressive effect on glutamate activity.
Have you tried adding a psychostimulant? I don't consider modafinil to be a psychostimulant, but rather, a promoter of wakefulness and vigilance. Amphetamine and methylphenidate are more robust stimulants and can help with energy, motivation, and anhedonia. I have read that methylphenidate is better for anhedonia. Focalin (dexmethylphenidate) would be my choice.
I'm sorry to hear that you have taken a dip. Maybe it is just temporary. If you do intense resistance training 6 days a week, I recommend that you allow 2 weeks for recovery by not performing any anaerobic resistance exercises. You can do some light aerobic exercise, just to help maintain your calorie balance.
- Scott
Posted by tensor on January 9, 2013, at 3:33:46
In reply to Re: An update » tensor, posted by SLS on January 9, 2013, at 2:27:19
> Hi Tensor.
Hi Scott!
> What kind of exercise do you do? There is such a thing as over-training, in which case you could experience a drop in energy and motivation. I don't know about anxiety, but I imagine it is possible that it gets worse if you are under physiological stress.
3x resistance-training and 3x cardio / week no more than 1h per session. I have been doing this for five and a half months.
> New drugs? I don't think there is anything new since your last visit...
>
> The most recent antidepressant is Viibryd (vilazodone). It is a serotonin reuptake inhibitor and serotonin 5-HT1a partial agonist.Yeah I know about this one, it's interesting but I don't think it's for me, never had any luck really with SRI and the like.
> Latuda (lurasidone), already available as an antipsychotic, will soon be approved for depression. It is a sister drug to Geodon (ziprasidone), and has 5-HT7 antagonism as an antidepressant property.
I was thinking of testing Geodon in the past but I had some success with Seroquel so I stuck with it. Its NE and 5HT reuptake properties are unique. Lurasidone is not available here yet, although it could be imported.
> Saphris (asenapine), and antipsychotic, has an interesting pharmacological profile, including NE alpha-2 antagonism (similar to Remeron). It can be energizing.
This is almost like Zyprexa and Remeron in one pill, it was considered before I started Seroquel.
> Minocycline seems to work well for depression in some people. It is an anti-inflammatory and is also anti-glutamatergic. There is a possibility that it might work particularly well with Lamictal. Minocycline can take months to exert its full effect, although the two people I know who take it (including me) experienced an improvement during week 1.
This one is new for me, never would have guessed and antibiotic as antidepressant! :-) Nice to hear you are having some luck with it, how long have you been taking it?
> I am having luck with prazosin. It might be particularly beneficial to people who have PTSD or a history of chronic childhood traumas (developmental PTSD). To me, it feels like an antidepressant.
Blocking effects of NE?
> NAC (N-acetylcysteine), a food supplement, is still being promoted by the NIMH and people at Harvard for treating depression. I had a bad reaction to it. It made my depression moderately worse. NAC can take 3 months or more to work. It is a precursor to a powerful antioxidant, glutathione, and has a suppressive effect on glutamate activity.
It seems to have a wide range of uses. Treating OCD and hangover(!)
> Have you tried adding a psychostimulant? I don't consider modafinil to be a psychostimulant, but rather, a promoter of wakefulness and vigilance. Amphetamine and methylphenidate are more robust stimulants and can help with energy, motivation, and anhedonia. I have read that methylphenidate is better for anhedonia. Focalin (dexmethylphenidate) would be my choice.
No I haven't and this is actually what I would like to try next instead of modafinil (which is rather useless nowadays). We do not have dexmethylphenidate here, only methylphenidate in forms of Ritalin and Concerta. So I guess Concerta would be the better candidate? I'm going to bring this up with my pdoc tomorrow morning.
Is stimulant and exercise going to be a problem? I'm thinking about cardiac issues.> I'm sorry to hear that you have taken a dip. Maybe it is just temporary. If you do intense resistance training 6 days a week, I recommend that you allow 2 weeks for recovery by not performing any anaerobic resistance exercises. You can do some light aerobic exercise, just to help maintain your calorie balance.
It may be a temporary thing, I don't know, but I feel more restless at work and I find it more difficult to concentrate and a workday feels much longer now than a month ago. As I wrote above, resistance-training three times a week, I don't really know the symptoms of overtraining but isn't elevated resting pulse one of them? I have normal resting pulse.
I do have chills and I sweat in the evenings, don't know what's up with that, have had it for months.
Thanks for your thorough update Scott, very appreciated!/tensor
Posted by Phillipa on January 9, 2013, at 9:00:24
In reply to An update, posted by tensor on January 9, 2013, at 1:37:44
Tensor glad to hear you have been doing well and working. I excercise 7 days a week. But it isn't intense just bike riding. What kind of work do you do? Think the dip is from the cold winter? SAD kind of dip Phillipa
Posted by tensor on January 9, 2013, at 9:15:01
In reply to Re: An update » tensor, posted by Phillipa on January 9, 2013, at 9:00:24
> Tensor glad to hear you have been doing well and working. I excercise 7 days a week. But it isn't intense just bike riding. What kind of work do you do? Think the dip is from the cold winter? SAD kind of dip Phillipa
Hi Phillipa!
I work with computers, so I'm sitting still all days. I have never seen a pattern in my dips that would suggest SAD, but the lack of sunlight certainly does not help. IIRC you're pretty high up in the north too?
Exercising is good, not sure how much it helps my depression/anxiety really, I mean I'm really pushing myself at the gym, especially the cardio. But it's nice to be in better shape physically though.BR,
tensor
Posted by Phil on January 9, 2013, at 10:29:46
In reply to Re: An update » Phillipa, posted by tensor on January 9, 2013, at 9:15:01
When I was running all the time(jogging really) and trying to up the distance, I really started getting more and more depressed.
Before you jump back on the med go round try cutting back to 30 minutes just as an experiment.
My 2c which may be totally useless.
If you're 25 that regimen may be fine. If you're 55 try cutting back temporarily.
Too much, too hard is not beneficial in all cases, burnout.
This is the end of the thread.
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