Posted by Pfinstegg on November 8, 2002, at 9:51:48
In reply to Lamictal is making me suicidal, posted by Jerrympls on November 7, 2002, at 22:58:10
Hi.. I'm so sorry to hear how hard things are. One thing you said jumped out at me: that the depression clears when you take corticosteroids. I know you can't take them for an extended period because the physical side effects become very dangerous, but it gives a real clue as to what is wrong: you must have the type of depression that is caused by (or follows?) HPA axis dysregulation. If this is so, you would have non-suppression on the DST suppression test, excess 24-hour urinary cortisol, and probably a number of other abnormalities, such as slight thyroid dysfunction and a smaller-than-normal hippocampus. The hard thing about looking at depression from this point of view is that, while it is physiologically correct, it is very difficult to know what to do.
I have this exact type of depression, and have not been helped very much by any SSRIs or psychotherapy. I am in the process of trying to address the underlying brain abnormality. I have found an excellent neuroendocrinologist, and have had a thorough work-up, which indeed showed an abnormally small left hippocampus on MRI, non-suppression on DST, too high 24-hour urinary cortisol and hypothyroidism.
The things we have decided to do are:
1. use tianeptine, a European anti-depressant, not so much for its AD properties, which are not huge, but for its ability to protect the hippocampus and allow it to regain normal size- this is experimental, as it has been demonstrated in tree shrews but not humans.
2. add Cytomel to synthroid supplementation- it has been shown to have an AD effect.
3. join a trial of rTMS; when it is successful, you convert back to being a DST suppressor, and cortisol levels return to normal.
This is the present plan; if these don't work, he will consider other things such as mifepristone or ketanozodole. However, he would like more time to watch the clinical trials of these things going on now. Even further on, there might be the possibility of CRH antagonists, Substance P antagonists, etc., but these are a number of years away from safe clinical use.
It was a big mental jump for me to begin looking at my MDD as a physical disorder, mainly involving my brain, but also my adrenals and thyroid. I am not well yet, and may never be, but I have improved on tianeptine and Cytomel, and am due to start rTMS on the day after Christmas.
I do hope you will find the right thing for you, and that what I have told you could be a help.
Pfinstegg
poster:Pfinstegg
thread:126920
URL: http://www.dr-bob.org/babble/20021108/msgs/126949.html