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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 nick on February 2, 2000, at 21:07:25
I was wondering if you might have some, advice, perhaps for me.
I have been seeing psychiatrists on and off for over ten years.
I am 32 y/o and I have tried every antidepressent on the market.
The only med that seems to work for me is klonipin at
around 5 to 6 mgs a day all in the morning(or mostly).
I read your thoughts on this med, and I do agree with you
100 percent and there are other effects on ones personality
that you did not mention (effects in my case anyway)
but there seems to be no other way to relize life
as I choose it. As far as I know, I'll only get one
chance on this planet, and life is short. In other words
there is no other med that I have taken that allows me to
be "me". Before I began taking klonipin I felt as though
I was powerless in the world to exert my will and social
potential. I was a very lonly and weak (emotionally).
And I get no sympathy for my illness for although I
am of average height 5'11" I am addicted to exercise,
and I am above averge looking but I have been told that
there is an intimidating look about me. So I would
imagine that I exude masculine power. however, and I
know this is a reoinforcing statement, but the opposite
is more true. still though, people seem to be competetive
with me rather than sympathetic. That is not to say that
I feel I deserve eveyones pity, but rather understanding
I am not excluding family and most Doctors I have had to endure.
I am a veteran so I am seen by VA Dr's. "government
health care". Any way, I have tryed everything from
prozac, paxil, remron, effexor all the new anti-depress-
ents to lithieum, depakote and many others of which none
worked, or did anything other than make me very sleepy.
Where do I go from here. maybe I am seaching for answers
in the wrong place
Posted by jd on February 2, 2000, at 21:39:05
In reply to not sure, posted by nick on February 2, 2000, at 21:07:25
Nick,
Sorry to hear you've had such a frustrating experience--many of us on this board can definitely sympathize with you, even if others out there don't seem to. A couple questions come into my mind from reading your post. First, what is your sense of your basic "diagnosis"? (Chronic depression? Social phobia? Dysthymia? Something else entirely?) This can make a big difference in treatment options, obviously. Second, though you seem to have tried a great deal of the ADs out there, have you ever tried an MAO inhibitor like Nardil? Finally, since you have such a positive response to high-dose klonopin (which is an anti-convulsant), have you ever tried any of the newer anticonvulsants like Neurontin (gabapentin) that often help with mood? (For this matter, do you have any reason to suspect that you might have a subclinical seizure disorder, something that can definitely affect mood and that might explain your response to klonopin?) Just ideas, of course, but I figured they might be worth sharing...
Best to you,
jd> I was wondering if you might have some, advice, perhaps for me.
> I have been seeing psychiatrists on and off for over ten years.
> I am 32 y/o and I have tried every antidepressent on the market.
> The only med that seems to work for me is klonipin at
> around 5 to 6 mgs a day all in the morning(or mostly).
> I read your thoughts on this med, and I do agree with you
> 100 percent and there are other effects on ones personality
> that you did not mention (effects in my case anyway)
> but there seems to be no other way to relize life
> as I choose it. As far as I know, I'll only get one
> chance on this planet, and life is short. In other words
> there is no other med that I have taken that allows me to
> be "me". Before I began taking klonipin I felt as though
> I was powerless in the world to exert my will and social
> potential. I was a very lonly and weak (emotionally).
> And I get no sympathy for my illness for although I
> am of average height 5'11" I am addicted to exercise,
> and I am above averge looking but I have been told that
> there is an intimidating look about me. So I would
> imagine that I exude masculine power. however, and I
> know this is a reoinforcing statement, but the opposite
> is more true. still though, people seem to be competetive
> with me rather than sympathetic. That is not to say that
> I feel I deserve eveyones pity, but rather understanding
> I am not excluding family and most Doctors I have had to endure.
> I am a veteran so I am seen by VA Dr's. "government
> health care". Any way, I have tryed everything from
> prozac, paxil, remron, effexor all the new anti-depress-
> ents to lithieum, depakote and many others of which none
> worked, or did anything other than make me very sleepy.
> Where do I go from here. maybe I am seaching for answers
> in the wrong place
Posted by JohnL on February 3, 2000, at 3:18:30
In reply to not sure, posted by nick on February 2, 2000, at 21:07:25
I've been reading every book I can find on depression lately. A very interesting thing I've discovered that has massive implications is this...depressions characterized by poor response to ADs very often respond best to the same treatments used for ADD or ADHD. Even in the absence of any signs of ADD or ADHD. The cause of the depression is failed NE/dopamine. Stimulants reverse the failure. Sometimes an antipsychotic is needed as well, to reduce dopamine (too much is bad just as too little is bad). A stimulant will increase NE/dopamine activity in malfunctioning parts of the brain, while the antipsychotic will reduce dopamine in other parts of the brain where increased activity is not good. It sounds strange...raising neurotransmitter function with a stimulant while simultaneously decreasing neurotransmitter function with an antipsychotic. But they work in different parts of the brain. That explains it.
The basic idea is that when a depression is stubborn, confusing, and not responding to antidepressants, a drug from the stimulant class has a high probability of working. They will target the chemical imbalance or chemical failure when antidepressants fail to do so. If the stimulant overcompensates too much, a tiny dose of an antipsychotic will balance it out. Just like ADs, if one stimulant isn't right, another will be.
Interesting reading. This is the direction I will be going with my new pdoc in a few weeks, as my history is much like yours. It just always seemed to me that if three or four antidepressants didn't do the job, I was barking up the wrong tree. Depression can be caused by many different chemical imbalances or malfunctions, and only some of those are addressed by antidepressants. JohnL
Posted by CarolAnn on February 3, 2000, at 11:54:03
In reply to Re: not sure, posted by JohnL on February 3, 2000, at 3:18:30
JohnL, I think you hit the nail on the head regarding some depressions needing a stimulant. Nothing worked for me until my Pdoc prescribed Adderall. I take 10 mgs three times per day, and while it does not have a dramatically noticeable effect, I do *feel* a definite improvement in my mood (I've actually experienced happiness a few times recently!). I have more motivation and have even started taking a course in creativity (based on "The Artist's Way" by Julia Cameron) at my church. Having tried so many different medications, including a different stimulant(Ritalin), which were ineffective, I cannot say often enough, "Give Adderall a try, it might be just what you need!" CarolAnn
Posted by Tom on February 3, 2000, at 15:39:18
In reply to Re: Adderall, the wonder drug (at least for me), posted by CarolAnn on February 3, 2000, at 11:54:03
> JohnL, I think you hit the nail on the head regarding some depressions needing a stimulant. Nothing worked for me until my Pdoc prescribed Adderall. I take 10 mgs three times per day, and while it does not have a dramatically noticeable effect, I do *feel* a definite improvement in my mood (I've actually experienced happiness a few times recently!). I have more motivation and have even started taking a course in creativity (based on "The Artist's Way" by Julia Cameron) at my church. Having tried so many different medications, including a different stimulant(Ritalin), which were ineffective, I cannot say often enough, "Give Adderall a try, it might be just what you need!" CarolAnn
CarolAnn,
Do you take Adderall mainly for ADD and have depression as a co-existing condition as a result of dealing with the ADD? Or just for depression alone? Have you taken many ADs, in different classes, like the rest of us, until you tried the stimulant route?
Appreciate any info you can provide.
Posted by CarolAnn on February 4, 2000, at 9:21:08
In reply to Question for CarolAnn, posted by Tom on February 3, 2000, at 15:39:18
Tom, I actually went the stimulant route in order to relieve the extreme fatigue which my depression causes (I've suffered depression most of my life). I had never even considered the possibility of ADD, because I always associated it with hyper-activity (something I've *never* experienced!). Anyway, it wasn't until I read (here on this board) that there is such a thing as ADD without hyper-activity, that I began to research and discuss it with my Pdoc. With the symptoms I've experienced and my improvement on Adderall, my Pdoc now concurs with me that ADD is one of my problems.
Yes, I have taken different classes of ADs. Elavil, Zoloft, Prozac and Effexor(seperately and together). And finally, Wellbutrin. When I tried Ritalin, I was on the Prozac and Effexor mix. I had to force myself to stop the Ritalin because I was really abusing it. Hope this helps, if you have anymore questions, just ask!CarolAnn
>
Posted by michael on February 4, 2000, at 15:13:04
In reply to Question for CarolAnn, posted by Tom on February 3, 2000, at 15:39:18
> > JohnL, I think you hit the nail on the head regarding some depressions needing a stimulant. Nothing worked for me until my Pdoc prescribed Adderall. I take 10 mgs three times per day, and while it does not have a dramatically noticeable effect, I do *feel* a definite improvement in my mood (I've actually experienced happiness a few times recently!). I have more motivation and have even started taking a course in creativity (based on "The Artist's Way" by Julia Cameron) at my church. Having tried so many different medications, including a different stimulant(Ritalin), which were ineffective, I cannot say often enough, "Give Adderall a try, it might be just what you need!" CarolAnn
>
> CarolAnn,
>
> Do you take Adderall mainly for ADD and have depression as a co-existing condition as a result of dealing with the ADD? Or just for depression alone? Have you taken many ADs, in different classes, like the rest of us, until you tried the stimulant route?
>
> Appreciate any info you can provide.CarolAnn -
Just wondering, are you taking only adderall now? And you find that it helps w/motivation, mood, and energy? Did you have any issues with focusing/concentration? If so, did/does adderall help you in that area as well? Thanks for the feedback.
michael
Posted by CarolAnn on February 4, 2000, at 15:21:34
In reply to Re: Question for CarolAnn, posted by michael on February 4, 2000, at 15:13:04
michael, I take adderall and Wellbutrin (200mgs twice per day). Wellbutrin is supposed to be a stimulating anti-depressant, but it did not help me with energy at all. My mood improvement could be due to the Wellbutrin, although I had been taking it for 12 weeks with no effect what-so-ever, until I added the adderall. Energy and motivation, I definitely do attribute to adderall, and yes, it does help with focus and concentration as well. Keep in mind it is not a long acting drug like an anti-depressant. I take three 10mg. doses spread thru the day, and can tell a difference if I miss a dose. Hope this helps, if you think of anything else, ask away!CarolAnn
Posted by michael on February 5, 2000, at 18:31:23
In reply to Re: reply for michael, posted by CarolAnn on February 4, 2000, at 15:21:34
>
> michael, I take adderall and Wellbutrin (200mgs twice per day). Wellbutrin is supposed to be a stimulating anti-depressant, but it did not help me with energy at all. My mood improvement could be due to the Wellbutrin, although I had been taking it for 12 weeks with no effect what-so-ever, until I added the adderall. Energy and motivation, I definitely do attribute to adderall, and yes, it does help with focus and concentration as well. Keep in mind it is not a long acting drug like an anti-depressant. I take three 10mg. doses spread thru the day, and can tell a difference if I miss a dose. Hope this helps, if you think of anything else, ask away!CarolAnnCarolAnn-
Thanks for the response, you got every question I had for you. One more came to mind - ever had any experience with amantadine (an antiviral that I've read is sometimes used to augment AD's for anorgasmia/energy/mood - I believe it affects dopamine)?
By the way, I had the same experience with wellbutrin - 200mg twice daily - with the same results (or lack thereof?) that you had. Thanks again, and good luck.
michael
Posted by CarolAnn on February 6, 2000, at 10:37:00
In reply to Re: reply for michael, posted by michael on February 5, 2000, at 18:31:23
michael, no I never tried amantadine, but probably would have gotten around to it if the Adderall hadn't turned out to be effective. Good Luck to you too!CarolAnn
>
This is the end of the thread.
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