For Margrove only please
Question:
- Hide quoted text — Show quoted text – That sadi, it is possible that it can have a somewhat rapid onset but I would guess, that most likely it is just doing some calming of some overtly excited neurons in your brain-it takes about 2 weeks to really stabilize in serum and usually a long acting drug is used after initial titration -that’s when the effect on affect is seen as being dramatic. Thank you for your answer. Yes, that’s what I have been feeling lately–my mnd is more calm and my body seems to follow. I don’t feel as hyper or hurried. Zoloft does act nore quickly then other ssri meds, that’s one reason I like it-it can like the others poop out as well…. One question I do have for you is this: My Pdoc wants me to take the Zoloft down to 100 mg from the 200 mg as the Lithium kicks in. That means a 50mg reduction every week for the next two weeks. Isn’t this a little too fast? At this rate, discontinuation symptoms can set in. If there’s no harm being done in the 175-200 mg range, is she assuming that higher doses of Zoloft are causing some mood cycling? this is probably what she believes-if in fact you are cyclothymic it may be true, but the ssri drugs rarely cause mania in bi polar disorders to become problematict, the tca’s do. It seems that bi polared brains respond differently to increases and decreases in 5ht then other people-so those who may actually have hypomania from a ssri usually do not have a bi polar disorder but are reactive to hyperserotonism -so even though you are at a higher dose, I would opine you were always a bit cyclic in mood-so I think reducing the dose may be premature until she observes what lithium does for you-changing two variables may add confusion-the high dose of zoloft may theoretically cause some unwarranted mood elevation into the realm of hypomania but I really don’t see that based on your writing or what you report as your feelings, usually it would pruduce "side effects" first and they may be things like "jittery, nervous, prssed speach, movement disorders, insomnia and excitability". It may be prudent to back off 25mg a week until you reduce it by 50mg once you are at a therapeutic level of lithium for several weeks but only if she notes some pressed affect-but I don’t think she will anyway while you are on lithium and seroquel-what she may see is that the benefit of adding lithium does little and then thinks she may want to increase the seroquel and this becomes a medical merry go round-one thing at a time is a better move in my opinion. Some people with a predisposition to mania do well using seroquel as monotherapy or lithium as mono therapy, you are on both now. She has not witnessed the level of your depression and how it manifests itself yet-she also has not done any psychometric testing and is basing her diagnoses on one visit-all poor indicators for making sweeping moves in your medical regimen-take one thing at a time, you have lived with this for some time now. It is time for a deeper evlauative process to me anyway. Sh’e the doctor, has had an opportunity to see you, so if this is concerning to you, just ask her if she would allow you to stay put for a while longer and make other adjustments after let’s say a month Wouldn’t it be better to stay at the higher dose at this time to see if Lithium will do better as an adjunctive med that as a replacement for 100 mg of Zoloft? If on my next vist I tell her the depression is coming back, she might assume I need more Lithium, when I may just be experiencing discontinuation from the Zoloft.-
my typing sucks and I don’t proof read -so sorry — The charter is available at: http://readystump.algebra.com/~asapm
Response:
If there’s no harm being done in the 175-200 mg range, is she assuming that higher doses of Zoloft are causing some mood cycling? I think reducing the dose may be premature until she observes what lithium does for you-changing two variables may add confusion-the high dose of zoloft may theoretically cause some unwarranted mood elevation into the realm of hypomania but I really don’t see that based on your writing or what you report as your feelings,
Thank you for your response, Margrove, which is always greatly appreciated. Maybe, just maybe, she responded to my verbally expessed desire to get rid of the Zoloft for good. I forgot to state this in my earlier post. If she is fulfilling my wishes, then I will take your sound judgment into account and hold on to the 200 mg Zoloft for now until the Lithium kicks in. Some people with a predisposition to mania do well using seroquel as monotherapy or lithium as mono therapy, you are on both now.
Yes, however, at very sub-therapeutic doses. She has not witnessed the level of your depression and how it manifests itself yet-she also has not done any psychometric testing and is basing her diagnoses on one visit-all poor indicators for making sweeping moves in your medical regimen-take one thing at a time, you have lived with this for some time now. It is time for a deeper evlauative process to me anyway. Sh’e the doctor, has had an opportunity to see you, so if this is concerning to you, just ask her if she would allow you to stay put for a while longer and make other adjustments after let’s say a month
Okay. Now may I ask you a question? My Pdoc seems open to her patients trying ADs they would like to try. I know that I need a good AD. However, the Zoloft doesn’t seem to pack a punch. At 200 mg, I still have some background depression. The Lithium has really calmed my mind, as it rarely races now,. and in a small way it has improved my mood. I’m back to my hobbies of old that required intense concentration but which were put away for a year because of the racing thoughts. What, in your experience, have been the best ADs for severe depression? My guess is that SSRIs *alone* won’t remit severe depressions. SNRIs? Or will an augmentation strategy do better, and, if so, which ones? — The charter is available at: http://readystump.algebra.com/~asapm
Response:
- Hide quoted text — Show quoted text – If there’s no harm being done in the 175-200 mg range, is she assuming that higher doses of Zoloft are causing some mood cycling? I think reducing the dose may be premature until she observes what lithium does for you-changing two variables may add confusion-the high dose of zoloft may theoretically cause some unwarranted mood elevation into the realm of hypomania but I really don’t see that based on your writing or what you report as your feelings, Thank you for your response, Margrove, which is always greatly appreciated. Maybe, just maybe, she responded to my verbally expessed desire to get rid of the Zoloft for good. I forgot to state this in my earlier post. If she is fulfilling my wishes, then I will take your sound judgment into account and hold on to the 200 mg Zoloft for now until the Lithium kicks in. Some people with a predisposition to mania do well using seroquel as monotherapy or lithium as mono therapy, you are on both now. Yes, however, at very sub-therapeutic doses. She has not witnessed the level of your depression and how it manifests itself yet-she also has not done any psychometric testing and is basing her diagnoses on one visit-all poor indicators for making sweeping moves in your medical regimen-take one thing at a time, you have lived with this for some time now. It is time for a deeper evlauative process to me anyway. Sh’e the doctor, has had an opportunity to see you, so if this is concerning to you, just ask her if she would allow you to stay put for a while longer and make other adjustments after let’s say a month Okay. Now may I ask you a question? My Pdoc seems open to her patients trying ADs they would like to try. I know that I need a good AD. However, the Zoloft doesn’t seem to pack a punch. At 200 mg, I still have some background depression. The Lithium has really calmed my mind, as it rarely races now,. and in a small way it has improved my mood. I’m back to my hobbies of old that required intense concentration but which were put away for a year because of the racing thoughts. What, in your experience, have been the best ADs for severe depression? My guess is that SSRIs *alone* won’t remit severe depressions. SNRIs? Or will an augmentation strategy do better, and, if so, which ones?
there is no "best" drug for any psychiatric disorder-best is what works for the patient. Each drug has a specific general profile which can be used to determine if it may be appropriate for a patient. I don’t know what you have tried or what its effects were to make any educated comment. Generally if monotherapy fails drugs that synergize the ad med are tried-you are using two of them lithium and seroquel-if you are not bi polar you could try a tca like pamelor or imipramine, if you weren’t on seroquel or lithium you could try an maoi, but there would be some drug to drug interaction with the other drugs you are using and there would be some risk that may not be worth trying them. If depression is the target and the primary disorder then waiting until a therapeutic level of lithium is achieved will determine what can be done next-if the depression is still prominent then replacing zoloft with another drug may be in order depending on what other drugs you have tried-trying to gain maximum effect from one drug is the best choice, if this doesn’t work then other drugs can be added. Your seroquel can be increased, or replaced with zyprexa or another newer neuroleptic, or the lithium can be dumped and valproate or carbamezapine given a shot, or if you are indeed not bi polar drugs like provigil or amphetamine analogues can be used, the zoloft can be augmented with a tca or another ssri-there are many many options-but they need to be addressed systematically under as controlled an environment as possible. I also highly recommend some cbt therapy-most likely on going for some time to help you find better ways to structure the way you respond to stimuli and challenges. Let’s not put the cart before the horse, wait and see how you respond to the lithium-if the zoloft still isn’t doing the job, but almost is, either increasing the seroquel or adding imipramine or desipramine in very low doses may help if there are no contraindications like cardiac disease or bi polar disorders-if you do have a bi polar issue then the brunt of the ad therapy will be in the form of an ssri or an snri-cymbalta would be my next choice augmented by novel ap drugs like the seroquel in higher doses or another one if they are tolerated-geodon is one that comes to mind which has pretty potent mood stabilizing effect comparable to lithum but has an extra 5ht kick in the pants aspect that is a bit more potent then seroquel and less zoning out then zyprexa-but again–just be patient for now and see how this pans over a few weeks — The charter is available at: http://readystump.algebra.com/~asapm
Response:
Generally if monotherapy fails drugs that synergize the ad med are tried-you are using two of them lithium and seroquel-if you are not bi polar you could try a tca like pamelor or imipramine,
I was mildly depressed today until the evening, and *very* tight and tense physically. This always begins the first Monday of the month, and picks up gradually until the first day of my cycle. Only light therapy and massage machines helped. I suspect high prolactin levels caused by the Seroquel of all things to be the cause of my lack of total remission. If there are high prolactin levels, then maybe folks on this newsgroup may be helped if their moods cycle with their monthly hormonal changes. Dopamine agonists IIRC may correct this imbalance. If depression is the target and the primary disorder then waiting until a therapeutic level of lithium is achieved will determine what can be done next-if the depression is still prominent then replacing zoloft with another drug may be in order depending on what other drugs you have tried-trying to gain maximum effect from one drug is the best choice,
I called my doc today and she offered to put me on Wellbutrin, 150 mg a day, and Zoloft 100 mg daily. Not a bad combo, but the hormone tests coming soon are probably going to be the most important. if this doesn’t work then other drugs can be added. Your seroquel can be increased, or replaced with zyprexa or another newer neuroleptic, or the lithium can be dumped and valproate or carbamezapine given a shot, or if you are indeed not bi polar drugs like provigil or amphetamine analogues can be used, the zoloft can be augmented with a tca or another ssri-
Well, Wellbutrin will be the secondary SSRI, and just because, like Lithium, it is used as an augmenting agent to an SSRI. I think that the Seroquel is screwing up with my hormones if the zoloft still isn’t doing the job, but almost is, either increasing the seroquel or adding imipramine or desipramine in very low doses may help if there are no contraindications like cardiac disease or bi polar disorders-if you do have a bi polar issue then the brunt of the ad therapy will be in the form of an ssri or an snri-cymbalta would be my next choice augmented by novel ap drugs like the seroquel in higher doses or another one if they are tolerated-geodon is one that comes to mind which has pretty potent mood stabilizing effect comparable to lithum but has an extra 5ht kick in the pants aspect that is a bit more potent then seroquel and less zoning out then zyprexa-but again–just be patient for now and see how this pans over a few weeks
Low-dose desipramine would be a good option. It does work for Chip here. Thanks you, Margrove. I like your info a lot, but I no longer believe this is a "neck up" problem entirely. My mood cycles are now more predictable than the weather. My sister has PMS-A, and my older sister had PMS-D. Apparently it runs in our family. — The charter is available at: http://readystump.algebra.com/~asapm
Response:
- Hide quoted text — Show quoted text – That sadi, it is possible that it can have a somewhat rapid onset but I would guess, that most likely it is just doing some calming of some overtly excited neurons in your brain-it takes about 2 weeks to really stabilize in serum and usually a long acting drug is used after initial titration -that’s when the effect on affect is seen as being dramatic. Thank you for your answer. Yes, that’s what I have been feeling lately–my mnd is more calm and my body seems to follow. I don’t feel as hyper or hurried. Zoloft does act nore quickly then other ssri meds, that’s one reason I like it-it can like the others poop out as well…. One question I do have for you is this: My Pdoc wants me to take the Zoloft down to 100 mg from the 200 mg as the Lithium kicks in. That means a 50mg reduction every week for the next two weeks. Isn’t this a little too fast? At this rate, discontinuation symptoms can set in. If there’s no harm being done in the 175-200 mg range, is she assuming that higher doses of Zoloft are causing some mood cycling?
this is probably what she believes-if in fact you are cyclothymic it may be true, but the ssri drugs rarely cause mania in bi polar disorders to become problematict, the tca’s do. It seems that bi polared brains respond differently to increases and decreases in 5ht then other people-so those who may actually have hypomania from a ssri usually do not have a bi polar disorder but are reactive to hyperserotonism -so even though you are at a higher dose, I would opine you were always a bit cyclic in mood-so I think reducing the dose may be premature until she observes what lithium does for you-changing two variables may add confusion-the high dose of zoloft may theoretically cause some unwarranted mood elevation into the realm of hypomania but I really don’t see that based on your writing or what you report as your feelings, usually it would pruduce "side effects" first and they may be things like "jittery, nervous, prssed speach, movement disorders, insomnia and excitability". It may be prudent to back off 25mg a week until you reduce it by 50mg once you are at a therapeutic level of lithium for several weeks but only if she notes some pressed affect-but I don’t think she will anyway while you are on lithium and seroquel-what she may see is that the benefit of adding lithium does little and then thinks she may want to increase the seroquel and this becomes a medical merry go round-one thing at a time is a better move in my opinion. Some people with a predisposition to mania do well using seroquel as monotherapy or lithium as mono therapy, you are on both now. She has not witnessed the level of your depression and how it manifests itself yet-she also has not done any psychometric testing and is basing her diagnoses on one visit-all poor indicators for making sweeping moves in your medical regimen-take one thing at a time, you have lived with this for some time now. It is time for a deeper evlauative process to me anyway. Sh’e the doctor, has had an opportunity to see you, so if this is concerning to you, just ask her if she would allow you to stay put for a while longer and make other adjustments after let’s say a month Wouldn’t it be better to stay at the higher dose at this time to see if Lithium will do better as an adjunctive med that as a replacement for 100 mg of Zoloft? If on my next vist I tell her the depression is coming back, she might assume I need more Lithium, when I may just be experiencing discontinuation from the Zoloft.-
– The charter is available at: http://readystump.algebra.com/~asapm
Response:
That sadi, it is possible that it can have a somewhat rapid onset but I would guess, that most likely it is just doing some calming of some overtly excited neurons in your brain-it takes about 2 weeks to really stabilize in serum and usually a long acting drug is used after initial titration -that’s when the effect on affect is seen as being dramatic.
Thank you for your answer. Yes, that’s what I have been feeling lately–my mnd is more calm and my body seems to follow. I don’t feel as hyper or hurried. Zoloft does act nore quickly then other ssri meds, that’s one reason I like it-it can like the others poop out as well….
One question I do have for you is this: My Pdoc wants me to take the Zoloft down to 100 mg from the 200 mg as the Lithium kicks in. That means a 50mg reduction every week for the next two weeks. Isn’t this a little too fast? At this rate, discontinuation symptoms can set in. If there’s no harm being done in the 175-200 mg range, is she assuming that higher doses of Zoloft are causing some mood cycling? Wouldn’t it be better to stay at the higher dose at this time to see if Lithium will do better as an adjunctive med that as a replacement for 100 mg of Zoloft? If on my next vist I tell her the depression is coming back, she might assume I need more Lithium, when I may just be experiencing discontinuation from the Zoloft. — The charter is available at: http://readystump.algebra.com/~asapm
Response:
Thank you for your response to my previous post. Apparently you are right..one cannot micromanage depression/anxiety into single receptors/aminies, etc. Yesterday I saw a new Pdoc who was totally different than any of the others I have seen before. She knows her meds well based on people’s personal experiences (not just pharmacological math), and did a throrough assessment. She did tell me that all of my thoughts processes, cycling of mood swings, brain lock of obsessive thoughts, and depression mixed with agitation/irritability, etc.–and especially the fact that the Zoloft did well and quickly semi-pooped out, was all indicative of Bipolar II. Well, yesterday, being a Christian, I prayed to God about what the heck was going on–why meds helped me feel better and think more clearly but didn’t quite get the job done. I then remained silent, to listen to Him..and lo, and behold, the unexpected Lithium came to my mind. I thought Lithium was for BPI only, so I semi-dismissed the thought. When I went to see her, she had mentioned Lithium as the only change she wanted to make in my med regimen at this time. I didn’t mention to her anything about Lithium. In fact, I wasn’t thinking of any med, and had little hope that *this* Pdoc had any brains, much less a heart. Her warmth was quite sincere–first Pdoc who possessed that value. Well, today I took that IR LIthium Carbonate, 300 mg twice already. My mind is quite calm, and I feel pleasantly happy, but not totally depression-free. Unexpectedly, I also feel unusually calm physically and unhurried–outside of a few obsessive thoughts here and there, my mind didn’t race all day as it has done before. Is this possibly a placebo effect? Can Lithium possibly work this fast? Or is it the (very) minor sedation that is responsible for the mind-calming effect? Thank you for your response. — The charter is available at: http://readystump.algebra.com/~asapm
Response:
- Hide quoted text — Show quoted text – Thank you for your response to my previous post. Apparently you are right..one cannot micromanage depression/anxiety into single receptors/aminies, etc. Yesterday I saw a new Pdoc who was totally different than any of the others I have seen before. She knows her meds well based on people’s personal experiences (not just pharmacological math), and did a throrough assessment. She did tell me that all of my thoughts processes, cycling of mood swings, brain lock of obsessive thoughts, and depression mixed with agitation/irritability, etc.–and especially the fact that the Zoloft did well and quickly semi-pooped out, was all indicative of Bipolar II. Well, yesterday, being a Christian, I prayed to God about what the heck was going on–why meds helped me feel better and think more clearly but didn’t quite get the job done. I then remained silent, to listen to Him..and lo, and behold, the unexpected Lithium came to my mind. I thought Lithium was for BPI only, so I semi-dismissed the thought. When I went to see her, she had mentioned Lithium as the only change she wanted to make in my med regimen at this time. I didn’t mention to her anything about Lithium. In fact, I wasn’t thinking of any med, and had little hope that *this* Pdoc had any brains, much less a heart. Her warmth was quite sincere–first Pdoc who possessed that value. Well, today I took that IR LIthium Carbonate, 300 mg twice already. My mind is quite calm, and I feel pleasantly happy, but not totally depression-free. Unexpectedly, I also feel unusually calm physically and unhurried–outside of a few obsessive thoughts here and there, my mind didn’t race all day as it has done before. Is this possibly a placebo effect? Can Lithium possibly work this fast? Or is it the (very) minor sedation that is responsible for the mind-calming effect? Thank you for your response.
bi polar diagnosis are very haute couter these days and are pretty tricky to diagnose-it takes some time, some tests, and a whole heap of evaluations-that said, lithium can be very good as an adjuvant drug to treat severe depressions that don’t respond all that well to standard ad meds-it is after all the putative gold standard of mood stabilizers and possibly the most widely studied compound in medicine. That sadi, it is possible that it can have a somewhat rapid onset but I would guess, that most likely it is just doing some calming of some overtly excited neurons in your brain-it takes about 2 weeks to really stabilize in serum and usually a long acting drug is used after initial titration -that’s when the effect on affect is seen as being dramatic. Zoloft does act nore quickly then other ssri meds, that’s one reason I like it-it can like the others poop out as well- When one is sensitive to the effects of these drugs and relatively vigilant and internally focused one can notice a drug working and believe this must be something good-then focus on that goodness-feel better and then "bam" they start to feel lousy again and doubt the effectiveness of the drug-using your response to zoloft or other drugs in no way completes a differential diagnosis for bi polar disorder-but this doesn’t mean you don’t have one or that in the least you may be a responder to mood stabilizing effects of lithium-by the way seroquel can have similar effects and can be augmentive to the lithium-you do find that drug also calms you down and clears your ability to cogitate-Make sure you get a serum lithium test done within 2 weeks and while you are at it since you are still on seroquel, have an sma done as well with a fasting blood sugar-time will tell about how well lithium wil work for you-let’s see how you feel after a serum shows you are on target for a few weeks- I certainly hope it helps you regardless of anyones dx — The charter is available at: http://readystump.algebra.com/~asapm
