Posted by JD on June 26, 1999, at 16:44:59
In reply to What tests do I need?, posted by JohnL on June 25, 1999, at 21:24:24
I've gone through a similar round
of tests lately, though unfortunately
not much very conclusive came out
of them! Among other things,
I'd recommend complete
thyroid, DHEA, cortisol, and
testosterone tests. With cortisol, try
to get 8am, 4pm, and 24-hour
excretion levels, as they can reveal
different things. (Have you already
done a suppresion test, too?)With dysthymia/anhedonia and the
med regimens you describe, there's
some reason to suspect a dopamine
component. Though you've tried
Wellbutrin, I wonder if you've ever
tried an MAOI, which would seem
logical to me. Amineptine and
amisulpride perhaps merit trials
too, perhaps even one of the newer
dopamine agonists starting to attract
some attention for use in depression.
Naltrexone augmentation
has clearly worked wonders for
certain people, too--from what I
understand, it doesn't always have
to combined with SSRIs, either.Wishing you the best,
JD> OK. I'm going back to square one. Next week I will see my doctor and request a full work-up for physical causes of depression. It's been 5 years since a bloodtest. I don't want to miss anything. What should I ask about? Thyroid, upper 1/4 of normal range, understand that. Cortisol? Ummm, what else? DHEA? Testosterone? I'm sure my doc will know, but I would like to know what you all think is important to check for.
>
> Background: Dysthymic since childhood. First major depression with psychotic features diagnosed in 1995. Labelled bipolar, though any possible hypomanic episodes were short, mild, and questionable at best. Always outpatient, able to function. Was OK on Paxil for a year. But impotence and bad sleep and a seemingly total recovery caused me to quit. Depression returned in 3 months, slow but sure. Since then, lots of counseling, Zoloft, Prozac, Serzone, Effexor, Wellbutrin, Pamelor, Remeron, Vivactil, Moclobemide, St. Johnswort, 5HTP, SAMe, and various combinations. Four problems: 1)Not effective at appropriate dose, 2) Disabling sexual side effects, 3)Terribly loud ringing in the ear, 4)Depression actually worsened by antidepressant. With all my sensitivities and atypical reactions to drugs, I can't help but think maybe there's something I overlooked. Thus the thought to get back to basics. Most recently went on Paxil again, hoping to augment with Naltrexone, but after just one week I was reminded of all the reasons I quit Paxil years ago that I forgot about...my hair falls out badly, I sleep badly even when I sleep all night, and of course that sex thing.
>
> If tests come out OK, I will discuss Buspar+Pindolol(saw a NYU study showing this combo to work great and fast, especially on symtpoms of apathy/anhedonia, MY symptoms!); or a stimulant; or maybe a second stab at Serzone; or, hey, I remember a doctor once saying Anafranil was great for sex. Was he being sarcastic, or it that true? And I still have a bottle of Naltrexone to try with whatever.
>
> Questions: 1. What tests should I ask for?
> 2. Anyone know if Anafranil (Clomipramine) is good for sex? Or was the doc joking.
> 3. Any other input?
>
> You all are great. Thank you much for your help. JohnL.
poster:JD
thread:7844
URL: http://www.dr-bob.org/babble/19990601/msgs/7891.html