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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by Girlnterrupted on October 30, 2005, at 9:57:54
I am so desperate. My depression is ruining every part of my life--social, job, sexual, and well, I basically have no life.
In short: I'm a female, late 20's, with a life-long chronic depression. I call it "social-depression" because it mostly affects my relationships with people.
Symptoms: Basically, I don't enjoy myself with people AT ALL. I feel uncomfortable, I want to leave, I don't have tolerance, I don't have the desire to be around them, and I don't enjoy it. I thought that was my personality and hated myself.. but it all changed one day...
3 years ago, a miracle happened. I tried an AD for the first time in my life: Celexa. In two weeks, taking 40mgs, I suddenly was CURED. I could not believe it when I got up that lucky morning. I was in school. I usually avoided people when I walked through the campus, I always felt self-conscious and uncomfortable. Suddenly my life gave a 180 degree turn, I swear to god. I started saying hi, striking conversations with people, talking and laughing, and just being SOOO happy that I could NOT believe it. I remember repeating to myself "Oh my God, I am NORMAL!! I am finally NORMAL!! I'm CURED!!!" It was amazing. I was so outgoing and talkative; I came up with the funniest things, and I was always in a great mood, sociable and happy. People told me I was "charismatic" while I had been "the quiet one" all my life.
That lasted for a whole year. It was the happiest year of my life. It might have continued, if my doctor hadn't had that "great" idea. He thought maybe I should switch to Lexapro, which was the new, "improved" version of Celexa. I thought, fine, I'll give it a try. That was the end of it all. Within a week, all the effects of Celexa vanished, and I got more depressed than I had ever been. I began crying for no reason, I felt awfully self-conscious, and I isolated myself from people. I didn't want to talk to anyone. I went right back on Celexa. It helped, but nothing like the first time. I raised the dosage, and nothing. It helped like a 30%, compared to a 95% the first time.
Ever since, I've been depressed as hell. It's been 3 years, and I've tried it all: Effexor, Zoloft, Paxil, Wellbutrin. Nothing works. I want my life back!
My theory is that I'm dopamine deficient. I drew this conclusion because the only agents that make me feel the way I felt on Celexa were: (a) Alcohol, and (b) Adderall. (Note: Adderall made me feel great--sociable and happy, but only the first days.. after that, I built tolerance. Now it does nothing.)
I know both substances supply dopamine, and hence my conclusion on the dopamine deficiency.
Could anyone suggest what else can I do to restore my chemistry and get my social system back to working? None of the psychiatrists I've seen seem to have a clue on what's wrong with me. I am wasting my entire life! I am locked in my room 24/7, keep losing jobs, haven't dated anyone in 3 years, don't keep up with friendships, and I'm just dead alive. Either I fix this, or I'd rather not live. This is not living, this is hell.
Please help me.
Posted by Keith Talent on October 30, 2005, at 11:00:28
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
Hi,
I sort of understand, having MDD and SP. I found that dextroamphetamine to augment an SSRI only helped for about a month. I agree with you that there is dopaminergic dysfunction in depression. Next month I'm seeing a new psych and will ask about (dex)methylphenidate (Focalin XR and Concerta) in the hope that they will provide more long-lasting benefits.
Can anyone else comment on whether this strategy might work?
K.
Posted by linkadge on October 30, 2005, at 11:39:52
In reply to Re: Treatment resistant depression, posted by Keith Talent on October 30, 2005, at 11:00:28
My experiences with stimulant augmentation have been horrable.
They do work, wonders. But I crash inevitably into a more intollerable depression than what began, then there's withdrawl to deal with.
Perhaps other have had more posative experiences.
Linkadge
Posted by willyee on October 30, 2005, at 11:41:29
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
Every thing u described about your social life i can relate to DIRECTLY,least know that much!
I was lucky enough to emerge mine at 20 yrs old so i did not have to endure it in high school,whew a high school in brooklyn it would not have been easy,luckly i was quite "normal" in high school.
Anyway as far as dopamine goes,one thing u might want to look into is LIQUID DEPRENYL.This is a under the tongue POTENT dopamine enhancer,and is not very expensive,and can be added to most current meds,even as little as 1 droplet a day for an overall benifit with your dopamine.Do a google on it,youll find tons of information on it.Very strong affinit for dopamine.
Just for the record,as i said the way u described ur social siutation is exactly like mine,here are some meds/combos that have helped me in the past and noted to work for some...
Stimulant/klonopin combo
Stimulant/klonopin/Nurontion combo
Stimulant or (AD)/xanax combo.Maois
Nardil (strong social effects)
Parnate(more stimulant)Quick depseration over the counter tools
Kava Kava= Refer to vault of Erowird on how to use,not the bottle.There they are more in detail with the herb used for social anxiety.Kava hits 15 sites of the brain at least,most local stores have some form of it,try to get capsules/
L-THEANINE Raises blood gaba/dopamine,creates calming waves in the brain,not a bad thing to have on stand by in the closet,a pill under the tongue can help.
L Taurine- Stablizes nerves circtrutiy in the brain,surpresses EXCITATORY nueros,affects gaba and does a bit else.Again not a god send,but def a cheap otc product that is KNOWN to be useful to many.taurine and the above otc products usualy resemable a med in some way,just not as potent.I.E taurine works close to the way many of your prescribed mood stablizers do.
Anyway good look,to u,to myself,to everyone we deserve better than this,we soooo much do
Posted by Keith Talent on October 30, 2005, at 11:51:17
In reply to Re: Treatment resistant depression, posted by willyee on October 30, 2005, at 11:41:29
Out of curiosity, many on this board have complained that clonazepam made them depressed, yet I've seen at least one Medline abstract that said that it may have antidepressant properties. Do any of you know which is true? The reason I ask is because I'm thinking of changing from clonazepam to alprazolam (which was commonly used in the early eighties for not just anxiety but mild depression).
Thanks, K.
Posted by willyee on October 30, 2005, at 13:36:14
In reply to Re: Treatment resistant depression, posted by Keith Talent on October 30, 2005, at 11:51:17
My two cents is taken only,or as a primary med,klonopin accumaltes very very fast and yess can depress the world out of you .
ON a different note,klonopin used with a AD,especialy as needed,when u feel anxious then just the smallest amount is needed,and u get to keep the heightened mood minus the anxiety.
Thats when klonop feels like an antidepressant,such little is needed to take a mixed high but anxious state and ease it to more of just a "comfortable" stage.
Also if you r having intense anxiety,racing thoughts,the relieaf klonopin can bring is so real and nice its simply therputic.
Klonopin is just so potent,and accumaltes so fast,i think xanax might be better used for a take everyday benzo but for the as needed one klono can work wonders,i owe a whole recent two years of work two it.A small pieace in te bathroom,a bit of walking around,and i was happy cause i felt calm enough to perform my job.
Posted by Girlnterrupted on October 30, 2005, at 14:18:58
In reply to Re: Treatment resistant depression, posted by willyee on October 30, 2005, at 11:41:29
Thanks for your advice, Willyee. You seem to have a great deal of information and knowledge on this subject. I appreciate your input. I actually knew that either Nardil or Parnate would probably be the most likely ADs to target my type of depression.
However, I have asked over 5 psychiatrists to prescribe them, and none of them would do it. They simply don't want to add an additional responsibility to their easy-money-making jobs. It was "too much of a risk" to prescribe an MAOI, especially when there's like 100 other new ineffective AD's that pose no risks, and they could simply keep me trying them and making money from it.But anyway, I'm very curious about the Liquid Deprenyl. Do you need a prescription in order to get it? Where can I buy it? Have you taken it? Is it as good as Nardil, or is it better/worse? (Never tried Nardil, but from what I've heard, it should work great for my type of depression.)
Thanks in advance for any information on this matter.
Posted by med_empowered on October 30, 2005, at 14:26:27
In reply to Re: Treatment resistant depression, posted by willyee on October 30, 2005, at 13:36:14
Hi! For the first poster...I also think boosting dopamine can help with depression; the problem for me is that stimulants don't really cut it long term. Wellbutrin+another med might help. High-dose (up to 600mgs) Effexor helps some people, but those kind of doses scare me b/c of side effects. Provigil might be helpful; its primarily an anti-narcolepsy drug, but it does seem to help some people with ADD and depression with minimal side effects...supposedly, tolerance is much less of a problem than with Adderall and other "traditional" stimulants. You could try a kind of stimulating tricyclic, such as Pamelor but..those tend to have side effects, and they can impair cognition. It kind of seems like you might benefit from something that works on serotonin without re-uptake inhibition, since that will tend to reduce dopamine levels...maybe Remeron (try for higher doses, like 30mgs, at nite to prevent weight gain) plus Wellbutrin (or Straterra) ?
For the poster about Klonopin...yeah, I don't know what the deal is with Klonopin being used for depression. I think it may have to do with the location of some of the research--from what I understand, alot of asian psychiatrists use benzos for depression. In the US, our conceptualization of depression has changed over the years; in the past, many people DX'd today would be DX'd as "anxious" and given something for that (Miltown, Valium, Xanax) which actually will help a lot of people (some studies show benzos, in the short-term at least, pretty comparable to prozac for depression relief). So...in countries where a different conceptualization of "depression" and "anxiety" is used, its possible that Klonopin could be popular b/c they're actually dealing with a slightly different problem. Also, since some depressed people may have very mild bipolar-type issues, Klonopin could help even out mood swings, which would make the antidepressant more effective and improve the overall quality of life. As for xanax...it can be a wonderful drug for some people ..I think the big reason antidepressants are so popular now is more big pharma marketing hype than actual effiacy or safety issues. I don't know how you'd do Xanax dosing for depression; usually the doses range wildly, from 2-10mgs/day, but that's for anxiety. Good luck!
Posted by Monkeyoga on October 30, 2005, at 15:34:50
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
I thought I was dopamine deficient also. I tried Celexa and it did nothing for me. Currently I am on Effexor XR 275 + Wellbutrin (I forget the dosage). This seems to keep me functional. Getting a better job helped also. I think the biggest factor in my recovery has been finding a good Pdoc. I think I'm one of the lucky ones. If I were you, I'd keep looking until I found one I thought was helping.
-Jamie
Posted by gibber on October 30, 2005, at 15:51:10
In reply to Re: Treatment resistant depression » Girlnterrupted, posted by Monkeyoga on October 30, 2005, at 15:34:50
Interrupted,
I wanted to add my two cents here. One poster mentioned liquid deprenyl which as far as I know is selegiline (an MAOI). MAOIs you don't want to mess around with and certainly cannot be combined with SSRIs. I have TRD and am marginally functional on prozac and strattera. I have an appointment this week and my doctor should be pulling me off those meds and trying nardil, parnate, or selegiline. the Selegiline patch should be out soon too which lessens the food restrictions.gibber
Posted by willyee on October 30, 2005, at 16:08:04
In reply to Re: Treatment resistant depression, posted by gibber on October 30, 2005, at 15:51:10
> Interrupted,
> I wanted to add my two cents here. One poster mentioned liquid deprenyl which as far as I know is selegiline (an MAOI). MAOIs you don't want to mess around with and certainly cannot be combined with SSRIs. I have TRD and am marginally functional on prozac and strattera. I have an appointment this week and my doctor should be pulling me off those meds and trying nardil, parnate, or selegiline. the Selegiline patch should be out soon too which lessens the food restrictions.
>
> gibber
Im rather confused by your post,you seem to be aganist Maois at first in your post,which is fine,but then you say you are planning to go on them?
Posted by willyee on October 30, 2005, at 16:22:42
In reply to Re: Treatment resistant depression (To Willyee), posted by Girlnterrupted on October 30, 2005, at 14:18:58
> Thanks for your advice, Willyee. You seem to have a great deal of information and knowledge on this subject. I appreciate your input. I actually knew that either Nardil or Parnate would probably be the most likely ADs to target my type of depression.
>
> However, I have asked over 5 psychiatrists to prescribe them, and none of them would do it. They simply don't want to add an additional responsibility to their easy-money-making jobs. It was "too much of a risk" to prescribe an MAOI, especially when there's like 100 other new ineffective AD's that pose no risks, and they could simply keep me trying them and making money from it.
>
> But anyway, I'm very curious about the Liquid Deprenyl. Do you need a prescription in order to get it? Where can I buy it? Have you taken it? Is it as good as Nardil, or is it better/worse? (Never tried Nardil, but from what I've heard, it should work great for my type of depression.)
>
> Thanks in advance for any information on this matter.
Common problem just about everywhere,best thing is to find and OLDER docter chances are they actualy remember using the drug,where as younger docs who say no prob never prescribed the drug and have no idea of the reaction,in that case of course they will not want to risk their jobs on a drug theyere not comfortable with.My doc now still remebers when she used parnate a lot.I guess i got lucky there.As far as deprenyl goes,its an maoi,however it is most recomended at doses very low,between 1-10 mg.At this dose there is a subtle over all change in dopamine,not a rush like a stimulant and a chrash.
The low dose on deprenyl is said to keep deprenyl OUT of the maoi danger zone,and the low dose range 1-10 mg should not require any food or med restrictions,this is debated,but it is also what is stated most about the drug.
For now keeping it low like that would make it a good second option,with a primary med,as stated with the low dose you SHOULD be able to add it to any med with out hardm,most people use 1mg or 2mg a day.
The product is tiny so u wont be using it in high doses anyway or you would run out in a day.Yes its prescription here in pill form,but the liquid form is sublinsgual and believed to be entirly more effective,i have used the liquid dose,and at one point exper tremondous relief from it.
The liquid form right now is available over seas only,non prescription.Deprenyl itself when it is raised over this small dose amount is no longer selective on dopamine,and instead at doses of 60 mg etc behaves the same as the Maois parnate and nardil.It at this dose would also carry the same combination no nos of maois.
So if ur want a primary maoi,at this moment u would want to continue ur search for a doc willing to give either parnate or nardil,to use as ur primary med.
Liq deprenyl would b good if u had a med already but it seemed to lack something,adding it might show a good response in aweek or so.
Lastly i myself am hanging on to the hope of the introduction here of DEPRENYL via skin patch,not only will this provide medication through the day,avoiding those little red pills,but it is also believed to be at ur higher doses and still carry no restrictions.We wont know for sure till its company somerset gets it out for us.
This is something im watching very very close,it sadly its my main OPTION OF HOPE NOW,a non existent medication,pretty sad huh.
I have tons of info on resources,tips for docs to get them,deprenyl etc,more than ud ever want,if u need anything contacnt me via yahoo pm message brklyn234,if i dont respond leave an offline.U might want to i think i have info u absolutly need.good luck
Posted by blueberry on October 30, 2005, at 17:17:32
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
I realize you don't have schizophrenia or psychosis, but take a look at the atypical antipsychotics. Low dose zyprexa or seroquel in addition to your favorite antidepressant.
The reason is because in combination with ssri's, the APs significantly raise dopamine levels in the parts of your brain affecting depression, while at the same time decreasing dopamine in other parts of the brain affecting anxiety. They are also being used as mood stabilizers.
The good thing about the APs is that they don't require long trials like the ADs do...you'll know as soon as two days to two weeks if they're helping you or not. But if you want to tweek the dopamine system without developing tolerance any time soon, the APs in combination with ADs can do that.
There is tons of research to support this. I am sharing my own experience as well. Low dose zyprexa and low dose prozac gave me the best five years of my life before they began to poop out. That's a long time for any med to work so well. Like you, I believe I have dopamine hypofunction, and am again on the hunt...which will probably end up being another ssri and another AP and hopefully another five years of goodness.
Posted by SLS on October 30, 2005, at 19:13:13
In reply to Re: Treatment resistant depression » Girlnterrupted, posted by blueberry on October 30, 2005, at 17:17:32
Don't forget about combining MAOI + AP if an SRI doesn't do the trick. Nardil + Zyprexa *should* make for one hell of a combination. You could even add amantadine and chromium picolinate to help prevent weight gain.
- Scott
Posted by gibber on October 30, 2005, at 19:39:12
In reply to Re: Treatment resistant depression, posted by willyee on October 30, 2005, at 16:08:04
Sorry to be unclear. When I said don't "mess" around with MAOIs I meant don't go into it without understanding potential bad reactions with any meds or food you currently consume. For many of us I know these risks are far outweighed by the benefits of a med that works. I'm not familar with an augmentation strategy using an MAOI so I can't comment on that. If SSRIs and low dose deprenyl works thats great!
Posted by Phillipa on October 30, 2005, at 20:11:56
In reply to Re: Treatment resistant depression » willyee, posted by gibber on October 30, 2005, at 19:39:12
Seems like the drug of choice is an MAOI. Fondly, Phillipa
Posted by Emily Elizabeth on October 30, 2005, at 21:25:52
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
I don't know as much abt neurotransmitters as others do, but I also am in my late 20's and have TRD. I was wondering if you have tried any Tricyclic Antidepressants? Desipramine seemed to help me some. Also, I have some lithium in my combo now and that seems to have helped some. I say "some" b/c my depression is not totally under control, but some meds seem to have made a dent in it. TRD is not fun.
Best,
EE
Posted by willyee on October 30, 2005, at 21:41:05
In reply to Re: Treatment resistant depression » willyee, posted by gibber on October 30, 2005, at 19:39:12
Ive seen it commonly used,lots of times to fight off negative sexual side effects of ssris....from what i read i dident see any problems at the very low dosees.
But yes it must be so,ssri plus maoi is never ever something to be toyed with,i mean i toy personaly with stimulants,tcas,etc with maois,but never would i use ssri in combo.
Deprenyl at the low dose dosent behave as the others,thats why its the ONLY one used in that sceniro.Also ssris can sometimes lower dopamine,so its believed,so again the low dose deprenyl used lightly is believed to help there.I have used liquid deprenyl and i do agree at low doses it does accumalte and work.
At high doses it can make u feel like a madman.
Posted by Girlnterrupted on October 31, 2005, at 0:54:54
In reply to Re: Treatment resistant depression, posted by willyee on October 30, 2005, at 21:41:05
Which one is the best?
Why do I get the idea that nothing really works? Everybody here seem to have tried all kinds of MAOIs, and nobody sounds like they have their depression under control. Is this our fate? Lots of advice, but we're all still sunk in the darkness?
Please, if someone is being successful, let us know. Otherwise, it sounds as if we have all the answers, but nobody is getting cured anyway.
Posted by jerrympls on October 31, 2005, at 1:01:48
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
This seems to happen more and more - or more people are talking about it: where the very first AD they were on helped them tremendously and either a) they decide they're back on track and stop the med or b) the doc gets a "great idea" and screws with the meds. Then depression returns and the person's depression becomes treatment resistant - even to the very first med that helped so much.
This happened to me too. I was on Trazodone 75mg at night (14 years ago). Iin 2 weeks I was perfect - NORMAL! After 3 months on it my doc said I was "back on track" and could stop it. Well, I stopped it and here I am 14 years later searching for a cure - not responding to conventional treatments. Now it's like I have to have a med to help me be social and laugh, a med to help me focus and be motivated, a med to help me relax and not worry so much and a med to put me to sleep each night.
I digress - but what is this phenomena of responding very well to the first med and then not repsonding to any meds following the discontinuation of the first med? Does the brain's chemistry become intelligent to future invading mood boosters? Do you think perhaps the brain fights against later treatments somehow? Figures them out and blocks their effects via downregulation, etc?
curious..
Posted by Girlnterrupted on October 31, 2005, at 1:21:49
In reply to Re: Treatment resistant depression, posted by jerrympls on October 31, 2005, at 1:01:48
> I digress - but what is this phenomena of responding very well to the first med and then not repsonding to any meds following the discontinuation of the first med? Does the brain's chemistry become intelligent to future invading mood boosters? Do you think perhaps the brain fights against later treatments somehow? Figures them out and blocks their effects via downregulation, etc?I have no clue, and I wish so bad I could answer that question. I swear to god that if there is no cure for me, I'm going to say good-bye to the world and end it for once. This is equal to any other terminal illness, except that nobody recognizes it and we must take full blame for it! It's even worse.
Does Dr-Bob ever show up at these forums? Would he be able to help us with this?
Posted by willyee on October 31, 2005, at 1:24:11
In reply to Re: Treatment resistant depression, posted by jerrympls on October 31, 2005, at 1:01:48
I would not be surprised to believe one of two scenerios,A the brain quikly defends aganist these foreign toxins,kinda like fool me once shame on you,fool me twice shame on me.
Second a more scary thought,and one i dont simply blow off,i cringe to think this but maybe well come to find these DRUGS are in no way MEDICATION,they were simply DRUGS,POISON and yess maybe we expereianced minor relieaf but its common that it dont last,what if these drgs are doing SERIOUS damage to our brain circuitary,its possable all it would take would be the first drug,from then on we are now truly hanidcapped and searching for a drug to fix a problem we dont KNOW EXIST brain damge and the very drugs we keep trying are the ones frying it more?
Well regardless whats done is done i suppose.As i said as long as these billions of dollers continue to roll in for these drugs like alibilfy cymbalta zyprexa etc then everyones pocket stays fat and acnowledging any problems with these drugs will be the last concern of many.
A stuffed wallet goes a long way!
Posted by willyee on October 31, 2005, at 1:38:32
In reply to Re: So Nardil vs Liquid Deprenyl Citrate?, posted by Girlnterrupted on October 31, 2005, at 0:54:54
Youre,i agree.I dont understand why this page doesent make front headlines,make jaws drop,make someone for gods sake say WHOA WHOA WHOA,we have a problem here.We are prob some of the most intelligent people due to experiance youll find in regard to drugs available,both public and professional,im sure lots of us would piss of p-docs with our questions.
And yet with people like sls,chairman,ed others we at best are getting medacore results.I and this is my belief or disbelief only ,can not accept the fact that a large majority or even a fair amount of people are not here but instead in remission.ANyone who has been here,i truly believe will return in remission to help.We see people who are still here now.
As for the Maois,they continue to be the drugs that offer many at least a functionable life.They hold good track records.Dont get me wrong my first year on parnate was bliss.As far as what to take,my recomendation,and just that only,is
A Parnate if u are in a EXTREME state of depression,practicaly unmobile,one foot in the hospital,in need of help yesterday.Reason is although parnate is as robust with its social overall success,it is however POWERFUL and kicks in super fast!
If u r gonna respond,likly u will,then its very possable for a parnate user to initaly respond in 48 hrs.Parnate also its unlikly to have the common worse before better syndrome,parnate when it works will be like a light switch,and i believe can get a bed ridden person up and cleaning the house .
Nardil- If youre just discouraged,but have no problem with patieance,u migt wanna try this one.Nardil is more sound so it will take longer,more like a common AD to build up and work.Also its possable to feel a little worse first,as u feel the side effects etc of the drug before the benifit.
But if u wait,u can expect the possable outcome to be a very IMPRESSIVE social boost,people speak of it in the terms u spoke of ur first drug.You find urself talking to people,interacting.
Also nardil has more unpleaseant side effects,weight gain,sexual problems are very common,parnate mostly over hyperness and insomnia.
Deprenyl id only recomend as a add on to a previous treatment,or if its gonna be in a combo of a benzo or such.You dont want to make liquid deprenyl ur primary med right now,its just too darn expensive,but we all wait for this patch!
Posted by ed_uk on October 31, 2005, at 14:44:41
In reply to Re: Treatment resistant depression, posted by jerrympls on October 31, 2005, at 1:01:48
Hi J!
When was the last time you tried trazodone?
ed
Posted by Phillipa on October 31, 2005, at 17:45:42
In reply to Re: Treatment resistant depression » jerrympls, posted by ed_uk on October 31, 2005, at 14:44:41
All I know is what you are all saying is true. The first time I took paxil after three months. The lethargy, tiredness all went away and I was able to return to work. But the next time I was on it it did nothing. And I've tried all the SSRI's and SNRI's and even nortiptalline, remeron and they have absolutely no effect on me good or bad. You'd never even know I'd swallowed a med. Wonder if the placebo affect is what makes someone think a med will work again. Even my Daughter who took prozac for a short while. Went back on it when life was not good. And she said I was right it just didn't work. Fondly, Phillipa
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