Posted by Elizabeth on August 22, 2001, at 10:54:01
In reply to Delurk... recently released from hospital, posted by sarahcat on August 21, 2001, at 23:25:40
Hi, Sarah. Welcome to babble-land. (insert handshake here) It's great that you feel comfortable delurking. I think that having a moderated forum for discussing this stuff (without having to worry about being verbally attacked) is a special gift.
I agree with what Zo said, and I have a few additional remarks.
> Now for my question: I've been in treatment for dysthymia with superimposed major depressive episodes for six and a half years (I'm 24 now).
"Double depression." Ouch. I have recurrent depression and panic attacks superimposed on ADD, which is sort of similar in some ways -- when I was just diagnosed with depression, the antidepressants got rid of the mood disorder, but the general problems that have been there all my life (and that may have contributed to the depression in the first place, although the depression is basically considered to be primary and "endogenous") were still there, so I wasn't functioning well anyway. Now I'm trying to figure out how to deal with the ADD. The first step was going off MAO inhibitors and switching to desipramine (which seems to work just as well without many side effects -- for me, the new drugs haven't done much, it's been the old tried-and-true stuff that really works)
> Over the years, I've tried Prozac, Zoloft, Celexa, and Wellbutrin; Depakote, Cytomel, Trazodone, Ritalin, and occasional Ativan have been tried as augmenters or adjunct meds. Now I'm on 300mg of Effexor XR, 900 mg of Lithium (300 tid), 1200mg Neurontin (300, 300, and 600mg dosing), and 2mg Risperdal (1mg bid).
Huh. How do you feel all that stuff is helping? Like, what helps with what?
What are your dysthymia and major depressive episodes like? What kind of symptoms do you get? (A project of mine has been trying to figure out what medications work for what types of depression by asking around and keeping track of stuff. Don't worry, it's not formal research and your name won't be mentioned if I ever do manage to put together some kind of paper on this! :-) )
> I was in the hospital for the first time a couple of weeks ago, and while in the hospital the psychiatrist there had me on 450mg of the Effexor, which my regular doc promptly returned back to 300mg (my regular doc was on vacation while I was in the hospital, preventing communication between the doctors) for fear of potential side effects.
How did you feel about being in the hospital? For a lot of people, it's a frustrating and demoralising experience, I think.
> I know 450 is a high dose of Effexor (Walgreen's wouldn't even fill it without hassle), but I'm starting to believe that I need that dose to feel better.
Ahh, don't you just love it when pharmacists try to second-guess your doctor without knowing anything about your history?
> Does anyone here have any experience with taking that amount (or higher) of Effexor?
Not Effexor (I got the serotonin syndrome after decreasing it from 225 to 187.5!), but I'm on a dose of desipramine right now that is probably resulting in higher-than-normal serum concentrations (due to slower-than-normal metabolism). I was taking 300 mg/day (this is the recommended maximum dose for *inpatients* -- for outpatients it's 200), but my serum level turned out to be very high so I cut back to 150. That didn't seem to be working nearly as well, though, so now I'm on 225 as a compromise. I haven't had a serum level test since I've been on the decreased amount, so I don't know how it is, but it's probably still well outside the accepted range (which is something like 100-300 ng/mL, IIRC -- my level was well over 600 when I was on 300 mg/day). So it might be that I just need a higher concentration of desipramine than the "normal" therapeutic range. My pdoc doesn't seem too worried since I'm not getting bad side effects. He does want me to get an ECG to make sure I'm not having cardiac toxicity, but that's going to be difficult, since I'm, uh, in between health insurance plans!
> Were your side effects increased? I don't really have any side effects with Effexor, but my doc is worried that it will increase my blood pressure. At this point I'm really starting to worry that I'm just treatment resistent.
No, if it was working at the higher dose, you should see if your blood pressure is elevated. (You might want to get a BP monitor for yourself; the digital ones are around $75-100, but the manual-inflating ones are more like $20-30, and it's pretty easy to learn to use one.) If so, consider antihypertensive therapy to compensate. (The antihypertensives that are considered least likely to exacerbate depression are the ACE inhibitors, I believe.) Finding an AD that works when you've failed to respond to other ADs is a precious gift; as Zo says, it's best not to mess with something that's helping, and to attempt to deal with the side effects if possible before giving up and moving on to something else. This is especially true if you have been unresponsive to many treatments already.
> Thanks in advance, and I look forward to becoming a more active part of psycho-babble.
I look forward to talking to you some more. Again, welcome.
-elizabeth
poster:Elizabeth
thread:75868
URL: http://www.dr-bob.org/babble/20010822/msgs/75933.html