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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by janejane on January 31, 2009, at 12:10:30
Hi everyone! I've been lurking here for the last few weeks and have learned so very much. Thanks to everyone!
So the thing is, I seem to have developed the dreaded SSRI apathy syndrome after 10 years of prozac use for double depression. My mood is fine (I'm not sad, in any case) but I've got major anhedonia, lethargy, mind mush, and probably other stuff that escapes me right now.
To address these problems, my new p-doc decided to switch me from prozac to cymbalta. I do feel less foggy (though still unfocused) and the depression hasn't resurfaced, but nothing much else has changed. After doing a bit of study here and elsewhere, I've concluded that I could probably benefit from some dopamine boosting. Correct?
Wellbutrin is not an options since it causes tinnitus and ataxia. I think Provigil sounds promising, but my p-doc is reluctant. She thinks it's an "interesting" suggestion, but has decided that we should try upping my cymbalta dose first. Am I the only one who thinks that if anything, it will make the apathy worse?
Anyway, I decided to take some initiative and sample an alternate dopaminergic option to address the apathy. Specifically, I bought a product called "True Focus" made by Now Foods. Two capsules contain 800 mg l-tyrosine and 300 mg l-phenylalanine, along with what seem to be relatively small amounts of taurine, grapeseed extract, potassium, DMAE, gingko, CoQ10, vitamin c and b-6. Suggested usage is 1-2 caps 1-2 times daily between meals.
I've taken one capsule (half dose) first thing in the morning for the last few days. This is followed by my morning latte a half hour later, and breakfast some time after that. Despite a welcome boost in energy, I have also been experiencing bothersome palpitations and hypertension that don't seem to be decreasing with continued use.
This morning, for instance, my BP got up to something like 155/95. Very uncomfortable to say the least. (I admit this was post-coffee, but coffee by itself does not do that to me.) I'm reluctant to take it later in the day because insomnia can be a problem with me, but maybe I should try to wait until the caffeine has worn off. I suppose another option to take even smaller dose, but it seems like I'm taking a pretty small amount as it is. No?
Another thought occurs to me as well, though. Do you think it's possible that taking additional taurine along with the supplement would moderate the heart-fluttery effects I'm getting now? My theory is that I should still get an increase of DA and NE but not so much adrenaline, which seems like it might help keep me from being over-activated. Yes, no, maybe so? I thought I'd consult my fellow babblers about this before proceeding, because in all honesty, all this complex brain stuff is quite new and very confusing to me and I'm just starting (I think) to grasp the very tiniest strands of it. Thoughts?
Thanks in advance for your input!
Posted by janejane on January 31, 2009, at 12:19:57
In reply to tyrosine, phenylalanine... taurine?, posted by janejane on January 31, 2009, at 12:10:30
Oops. Looks like I made at least one grammatical error above. Oh well. I wanted to add that I'm still taking cymbalta 60 mg at night. I also take a multi-vitamin, fish oil, and magnesium glycinate (for constipation and better sleep).
Posted by Phillipa on February 1, 2009, at 12:43:51
In reply to tyrosine, phenylalanine... taurine?, posted by janejane on January 31, 2009, at 12:10:30
Hi Jane I'd stop the supplement. That's me. True Focus will google it. Phillipa
Posted by Phillipa on February 1, 2009, at 12:47:31
In reply to Re: tyrosine, phenylalanine... taurine? » janejane, posted by Phillipa on February 1, 2009, at 12:43:51
Sounds stimulating with the norepenephirine and dopamine and cymbalta has norepenephine already could be overdose sydrome? I don't know hopefully someone will answer with more knowledge. Phillipa
Posted by janejane on February 2, 2009, at 17:09:06
In reply to Re: tyrosine, phenylalanine... taurine? » Phillipa, posted by Phillipa on February 1, 2009, at 12:47:31
Thanks for the input, Phillipa. I think you're right that the combo of cymbalta and True Focus is too activating. With that in mind, I decided to skip the cymbalta entirely yesterday and took 25 mg of 5-htp instead. (I've been wanting to try a completely "natural" approach for a while so I guess I made the decision that this was the time.) I took one capsule of True Focus this morning, then had coffee and breakfast about an hour later. No palpitations or hypertension (well, BP was a little high after the coffee, but that's to be expected). I had two 25 mg doses of 5-htp (spaced out) today. I've been experiencing some mild brain zaps and a little nausea, but ginger got rid of the nausea. I think I'm going to try this approach for a little while, assuming I can tolerate it. If I start feeling down, I'll go back to the cymbalta. I'm guessing that'll be the most likely thing to happen, but I'll feel better for having tried. :)
Posted by Phillipa on February 2, 2009, at 20:29:48
In reply to Re: tyrosine, phenylalanine... taurine?, posted by janejane on February 2, 2009, at 17:09:06
Seriously do hope it continues to work for you. But then you'll know for sure. Phillipa
Posted by Lao Tzu on February 3, 2009, at 7:12:41
In reply to Re: tyrosine, phenylalanine... taurine? » janejane, posted by Phillipa on February 2, 2009, at 20:29:48
Have you tried combinations of specific vitamins? This has helped me a lot.
Possible combinations: B12, B6, B1, vitamin C and vitamin E, fish oil, borage oil, calcium. With vitamin cocktails, the dosage of each vitamin is extremely important. You'd have to determine how much you can tolerate of each vitamin.You could also add a very low dose of zinc to the cocktail for a better antidepressant response.
These are the dosages that I can tolerate:
Vitamin C- 500mg in the morning.
Vitamin E- 100IU in the morning and 300IU at bedtime
Vitamin B6- 100mg in the morning
Vitamin B1- 100mg in the morning
Vitamin B12-anywhere from 250mcg-750mcg per day
Zinc- 12-15mg in the morning and at bedtime
Calcium- 300-600mg per day or every other day
Fish oil-I can tolerate only a low dose of fish oil consisting of 210mg EPA and 130mg DHA. That's all for me.
Borage oil-1 or 2 1,300mg capsules per day. Best taken at same time as fish oil.
For better sleep, these are the supplements I take at bedtime:Niacin sustained release--250-750mg
Vitamin E natural--300IU-400IU
Vitamin B6 (P5P form)--50-75mg
melatonin supplement--1/4 piece of a 3mg tablet
zinc gluconate or picolinate--12-15mg
Could try adding 200mg magnesium oxide every other night. This might help.
Niacinamide has also helped me with sleep, about 30mg with the other supplements. However, I am very sensitive to niacinamide so I can only take it a few nights per week.Hope this is helpful information for you.
Posted by janejane on February 3, 2009, at 7:25:47
In reply to Re: tyrosine, phenylalanine... taurine? » janejane, posted by Phillipa on February 2, 2009, at 20:29:48
Thanks, Phillipa. I decided that I was probably trying to do too many things at once, so I'm going to keep the cymbalta constant while trying additional things for the apathy. I think I'm going to get some plain old tyrosine next. Hopefully it won't be too activating just by itself.
Posted by janejane on February 3, 2009, at 8:31:01
In reply to Re: tyrosine, phenylalanine... taurine?, posted by Lao Tzu on February 3, 2009, at 7:12:41
Thanks for the suggestions, Lao Tzu! I have tried just about everything you mentioned at one time or another. But I've never been systematic about trying to tweak doses for maximum effect. I've been thinking that I need to start a diary and keep track of what I take and how I feel.
Posted by Phillipa on February 3, 2009, at 20:24:10
In reply to Re: tyrosine, phenylalanine... taurine?, posted by Lao Tzu on February 3, 2009, at 7:12:41
Thank-you anxiety is the biggest problem for me. I used to be very active in Shaklee supplements until about l0 years ago lost touch with my person under. They used to be my only source of any type of treatment. I trusted the products so much. But then they moved out of USA and hear the products arent as good. I had an ob-gyn prescribe B6 for me when younger and had pms very good for water retention. Seems like B's Vitamin Shoppe Brand are very activating to me too much so. So right now on the C 2000 total mg calcium citrate, extra magnesium at bedtime. Which brand do you recommend as best now? And being post menopausal was told not to take iron anymore yet hemoglobin and hematicrit run on low side of normal. B 12 I heard was good. Love Phillipa
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