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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Karen on February 9, 2000, at 2:42:13
Is there anyone out there who has tried anticonvulsant-mood stabilzers like Neurontin or Lamictal for unipolar depression (chronic/atypical)? I have tried 16 different antidepressants over the years and none has had any benefit. Now I`m trying combinations, but the odds of zero plus zero equaling one seem pretty remote. I`ve tried augmenting AD`s with lithium(couldn`t tolerate it), thyroid (ditto), and buspar(did nothing). My doctor didn`t seem to think there was much point in adding a mood stabilizer since I`m not bipolar, but I`m running out of options. I`m certainly never manic, just go back and forth from numb/empty to overwhelming pain/self hate. Therapy made me worse. Just like to know if anyone who`s not bipolar has benefited from a mood stabilizer-thanks for any info.
Posted by JohnL on February 9, 2000, at 5:13:38
In reply to Mood stabilizers for Unipolar Depression, posted by Karen on February 9, 2000, at 2:42:13
Karen,
I think a flaw in general psychiatry is the assumption that an antidepressant should fix depression. And that if one doesn't, another will. This just isn't so in some cases, as I understand it. The reason is because there are many different malfunctions that can cause depression, just as there are many different things that can cause diarrhea, right? Antidepressants won't always target whatever problem is causing the depressive symptoms. And thus multiple failures on antidpressants.
I know a woman who finally found total cure on just Depakote, after failing just about every other drug for 20 years. Ironically, Depakote can make a significant number of other people more depressed. A regular poster we used to see here a lot found total cure with Naltrexone, after decades of failing everything else including ECT. I know a woman who experienced total cure on her very first day of Wellbutrin. As I've said in other posts, and I have come to believe strongly, it all depends on how a particular drug target's the person's unique underlying problem.
The farther a drug is away from targeting the problem, the longer it will take to have a trickle down effect and work, if it ever works at all. The closer the drug, the faster the results with fewer side effects. It is common to get worse on the wrong drug. It would seem apparent with you that raising serotonin and/or norepinephrine does not target the underlying problem. If it did, you would have responded to an AD by now.
So looking at the mood stabilizers makes logical sense. Maybe one of those will target the underlying problem that so far has been missed. But I think there are even better choices for you at this point. It doesn't matter what the actual diagnosis of symptoms is. Some people with unipolar depression for example have found total cure with Lamictal, which is used in epilepsy and bipolar. I believe medication reactions provide important clues to guide treatment. The clues your history suggest are to stay away from antidepressants and focus instead on other psychiatric drug classes.
You sound like a classic case of someone who would respond nicely to a psychostimulant, the same drugs used in ADD or ADHD. Even if you have no symptoms at all of ADD or ADHD, you fit the profile very nicely of someone who will respond to a stimulant. If so, the underlying problem would be NE/dopamine failure, which no antidepressant will fix. But a stimulant will. Like all drugs, if one isn't a best fit, another likely will be. Sometimes stimulants overcompensate and require a small dose of an antipsychotic as well to counterbalance. But doesn't it make sense that if all those antidepressants didn't work, we're barking up the wrong tree? The answer might be something as simple as a child's dose of Ritalin with a tiny dose of Zyprexa. Simple and fast. If a stimulant is going to work, it will do so in 24 to 72 hours. No long wait to find out. They will quickly replace or mimic the failed brain chemicals.
If you respond negatively or neutrally to several stimulant trials, then the mood stabilizers would be the next logical place to look. In your shoes (actually I AM in your shoes) I think the stimulant class should be at the top of your priority list. No ADD or ADHD symptoms needed. With a history almost identical to yours, I responded robustly to Ritalin. Now I just need to explore the alternatives in that class to find a best fit and fine-tune dosing. Stimulants first, with a possible tiny adjunctive dose of an antipsychotic. Mood stabilizers second. That's what I would do if I were you. To hell with the antidepressants. You already know all to well they don't work for you. There are important clues in all those antidepressant failures. JohnL
Posted by PattyG on February 9, 2000, at 6:10:06
In reply to Mood stabilizers for Unipolar Depression, posted by Karen on February 9, 2000, at 2:42:13
Karen,
Could you explain a little more to me about unipolar depression (chronic/atypical?)
And John, how did you convince your doctor to prescribe an amphetamine? Most seem reluctant to do this:( (But it sure makes sense to me!)
Posted by Sean on February 9, 2000, at 12:02:34
In reply to Re: Mood stabilizers for Unipolar Depression, posted by JohnL on February 9, 2000, at 5:13:38
> Karen,
>
> I think a flaw in general psychiatry is the assumption that an antidepressant should fix depression. And that if one doesn't, another will. This just isn't so in some cases, as I understand it. The reason is because there are many different malfunctions that can cause depression, just as there are many different things that can cause diarrhea, right? Antidepressants won't always target whatever problem is causing the depressive symptoms. And thus multiple failures on antidpressants.
>
> I know a woman who finally found total cure on just Depakote, after failing just about every other drug for 20 years. Ironically, Depakote can make a significant number of other people more depressed. A regular poster we used to see here a lot found total cure with Naltrexone, after decades of failing everything else including ECT. I know a woman who experienced total cure on her very first day of Wellbutrin. As I've said in other posts, and I have come to believe strongly, it all depends on how a particular drug target's the person's unique underlying problem.
>
> The farther a drug is away from targeting the problem, the longer it will take to have a trickle down effect and work, if it ever works at all. The closer the drug, the faster the results with fewer side effects. It is common to get worse on the wrong drug. It would seem apparent with you that raising serotonin and/or norepinephrine does not target the underlying problem. If it did, you would have responded to an AD by now.
>
> So looking at the mood stabilizers makes logical sense. Maybe one of those will target the underlying problem that so far has been missed. But I think there are even better choices for you at this point. It doesn't matter what the actual diagnosis of symptoms is. Some people with unipolar depression for example have found total cure with Lamictal, which is used in epilepsy and bipolar. I believe medication reactions provide important clues to guide treatment. The clues your history suggest are to stay away from antidepressants and focus instead on other psychiatric drug classes.
>
> You sound like a classic case of someone who would respond nicely to a psychostimulant, the same drugs used in ADD or ADHD. Even if you have no symptoms at all of ADD or ADHD, you fit the profile very nicely of someone who will respond to a stimulant. If so, the underlying problem would be NE/dopamine failure, which no antidepressant will fix. But a stimulant will. Like all drugs, if one isn't a best fit, another likely will be. Sometimes stimulants overcompensate and require a small dose of an antipsychotic as well to counterbalance. But doesn't it make sense that if all those antidepressants didn't work, we're barking up the wrong tree? The answer might be something as simple as a child's dose of Ritalin with a tiny dose of Zyprexa. Simple and fast. If a stimulant is going to work, it will do so in 24 to 72 hours. No long wait to find out. They will quickly replace or mimic the failed brain chemicals.
>
> If you respond negatively or neutrally to several stimulant trials, then the mood stabilizers would be the next logical place to look. In your shoes (actually I AM in your shoes) I think the stimulant class should be at the top of your priority list. No ADD or ADHD symptoms needed. With a history almost identical to yours, I responded robustly to Ritalin. Now I just need to explore the alternatives in that class to find a best fit and fine-tune dosing. Stimulants first, with a possible tiny adjunctive dose of an antipsychotic. Mood stabilizers second. That's what I would do if I were you. To hell with the antidepressants. You already know all to well they don't work for you. There are important clues in all those antidepressant failures. JohnLAgreed. There are simply too many pathways capable
of producing the common symptomology of depression
to classify treatments and diagnoses into rigid categories.I think the unipolar/bipolar dichotmoy is oversold.
Kraepelin and many of the early psychiatrists noted
the recurrent nature of "unipolar" depression and
considered it a variant of manic depression. My guess
is that we will eventually tease out pure unipolar
from bipolar, but at least 50% of unipolar people
will be in the bipolar spectrum. For these people,
antidepressants are probably not a good idea and
the treatment of choice will be a mood stabilizer.Speaking of which, my experience with Neurontin
has been good in this respect...I say go for it.
Posted by Noa on February 9, 2000, at 16:02:49
In reply to Re: Mood stabilizers for Unipolar Depression, posted by Sean on February 9, 2000, at 12:02:34
There is a nice discussion in Goodwin and Jamison Redfield about the issue of whether unipolar depression is distinct from bipolar, or whether both are part of a spectrum of mood disorders.
I think the spectrum approach makes a lot of sense for many chronic depressions.
Posted by Janice on February 9, 2000, at 21:47:54
In reply to Re: Mood stabilizers for Unipolar Depression, posted by Sean on February 9, 2000, at 12:02:34
I've been following your story since I've been posting here @ Babbleland.
You sound and say you're doing well now. I'm very pleased for you.
I'm curious as to whether you are on an anti-depressant, plan to go on one again, or have decided you don't need one? Are you depressed at all?
I'm still looking because I'm still a bit depressed, especially in the winter.
Thanks Sean, Janice
Posted by JohnL on February 10, 2000, at 4:48:29
In reply to Re: Mood stabilizers for Unipolar Depression, posted by JohnL on February 9, 2000, at 5:13:38
Hi Patty,
To answer your question...I had no trouble at all convincing my pdoc to try a stimulant with me. Actually, it was his idea. The reasons were several. First, I have been only partially or negatively responsive to a variety of more standard medications. So logically it made sense to try a different class of drugs. Second, my pdoc is an oldtimer and he says back in the old days all they used were stimulants. Third, he says these days a stimulant can enhance the effectiveness of any antidepressant. He prefers this approach over things like Lithium, because he sees it as being safer, less toxic, and very fast acting. Fourth, he is interested in getting the patient well as quickly as possible. If a stimulant will work in a particular person, it will work very fast. He also says that in severe depressions, he will prescribe a stimulant along with an SSRI in the beginning of treatment. The stimulant will provide almost immediate relief while waiting for the SSRI to kick in.
If there is any sign of abuse or addiction, he will switch the patient to a different stimulant that won't pose those risks. Cylert for example is often effective in adults without the abuse potential of the other stimulants, he claims. I learned a lot about stimulants for depression in Dr Bob's Tips. I printed out all I found and brought it to my pdoc to sell him on the idea. But I wasted my time. He suggested it before I even pulled out my papers. He wrote out a prescription in 60 seconds. For pdocs who know, it's a no-brainer. Some of the newer pdocs might hesitate. But the old timers know the value of stimulants. Sometimes only a stimulant will target a person's unique chemical imbalance when everything fails to do so. The greatest benefit of all, as I see it, is how fast they can work.
The only downside risk I can see in stimulants is addiction. But then again, if the person is happy, well, and productive for the rest of their life, being dependent on the stimulant seems no different to me than a diabetic being dependent on insulin. Both keep the patient alive and well. JohnL
Posted by Noa on February 10, 2000, at 8:12:02
In reply to Re: Mood stabilizers for Unipola.....Patty G, posted by JohnL on February 10, 2000, at 4:48:29
It was my doc's suggestion, too. I was not getting enough AD response at the doses I tolerated, so he suggested ritalin to augment. It seemed really apt, too, since I had a lot of fatigue, which we later found out to be the result of sleep apnea. Even after the fatigue was controlled by treating the apnea (cpap machine), he wanted me to stay on the ritalin cuz it worked.
Posted by Noa on February 10, 2000, at 8:14:13
In reply to Re: Stimulant, posted by Noa on February 10, 2000, at 8:12:02
PS...I have never been tempted to misuse the ritalin, take more, or increase the frequency, etc. Which is not the case with cafeine--I have developed serious cafeine dependency many times, quit many times, only to get hooked again, needing more and more with less and less effectiveness.
Posted by Sean on February 10, 2000, at 12:12:52
In reply to Re: Mood stabilizers for Unipolar Depression, posted by JohnL on February 9, 2000, at 5:13:38
I'm doing ok for the most part. I still have
sleep problems so my doc has prescribed remeron.
Remeron + neurontin = one sleepy puppy the next
day! I don't take the remeron often enough to
feel an AD effect.Overall, I don't feel all that great. But not all
that bad either. Sometimes I feel a bit stupid
from the neurontin which kind bites, but you can't
have it all I suppose.I think an AD might help me feel more energized etc.
but my intuition tells me that the longer I stay
on a mood stabilizer, the more of an AD effect it
will have. In most optimistic moments I fantasize
that it is really repairing my poor neurons which
on top of all the crazy moods and anxiety they've
been through, have also been steeped in a plethora
of meds for like, over a decade. The periodicity
of my moods definitely quickened over time.So how about you? How are you doing and what's the
latest in terms of the whole med thing? Be well...Sean.
Posted by torchgrl on February 10, 2000, at 15:52:16
In reply to Re: Stimulant--PS, posted by Noa on February 10, 2000, at 8:14:13
> PS...I have never been tempted to misuse the ritalin, take more, or increase the frequency, etc. Which is not the case with cafeine--I have developed serious cafeine dependency many times, quit many times, only to get hooked again, needing more and more with less and less effectiveness.
This is all very interesting to me. I've never been a real caffeine addict; mostly, just drank Diet Coke 24/7 for years until I quit about a year ago, but that's not like drinking coffee all day like many people. One of the things that's plagued me all my life, though, is low energy/fatigue, and I'm kind of amazed that no one has ever suggested that I try any kind of stimulant or Ritalin--the best I've gotten is "energizing" ADs, which haven't helped.
Posted by PattyG on February 10, 2000, at 18:40:22
In reply to Re: Mood stabilizers for Unipola.....Patty G, posted by JohnL on February 10, 2000, at 4:48:29
Wow! You make me feel hopeful. I'm writing with regard to my son and when he says he feels tired all of the time, I believe him. He's been tired all of his life - that's not normal. We had just discussed printint out some of the messages and sending them to his psycdoc before he goes for his next appt. in the hopes he would consider prescribing a stimulant. However, I thought Cylert offered a risk factor to the liver, no? And.....you speak of abuse....I guess I'm naive, but if you have a prescription and the doctor controls the refills, then what is it someone can do to over medicate or whatever? I must be really green! Thanks so much for responding.
Posted by Janice on February 10, 2000, at 21:57:32
In reply to Hey Janice..., posted by Sean on February 10, 2000, at 12:12:52
my medications are pretty good. I'd say I'm 80% of the way there.
lithium & Dexedrine
the lithium stops the highs and prevents the bottom of the lows
the dexedrine keeps my energy stable, helps me eat properly, sleep, clean, organize, make small talk, and generally prevents me from most impulsive acts.
they are both like miracles.
but i am still mildly to moderately depressed and need an AD (although I haven't had much luck with them in the past).
when I read your post, it almost sounded like you had stopped even trying to find an AD.
I always assumed that no matter what mental disorder you had, you took an AD, so what I thought I understood, surprised me.
but you haven't stopped looking. good luck Sean, Janice
Posted by Karen on February 10, 2000, at 23:45:13
In reply to Re: Stimulant, posted by Noa on February 10, 2000, at 8:12:02
I`m extremely leery about the idea of stimulants as I`m already very anxious--do some people find they help mood without making you wired, anxious and unable to sleep-stimulating AD`s like prozac do this to me, so I imagine actual stimulants would be even worse.
Posted by JohnL on February 11, 2000, at 2:43:46
In reply to Re: Mood stabilizers for Unipola.....JohnL, posted by PattyG on February 10, 2000, at 18:40:22
Karen, being edgy to begin with doesn't predict that a stimulant will only make it worse. As a matter of fact, I know someone who tried everything in the book for years to try to treat anxiety. An adventurous and very smart pdoc cured her completely with...you'ld never guess....a child's dose of Ritalin. A stimulant of all things. For anxiety? I think the moral of the story is that if the stimulant corrects the underlying chemical imbalance/failure, then the symptoms will disappear, regardless of what symptoms they actually are. After all, stimulants actually calm down millions of hyper kids, right?
Patty, you are correct that Cylert has some liver risk. It is one of those drugs that requires periodic blood testing 2 or 4 times a year to monitor the situation, from what I've read. You have a good point about abuse potential. I mean, how can one abuse the drug when dosing is limited? A doctor can only prescribe one month at a time. And it requires a hard copy prescription, not a phone call to the pharmacy. So any addiction or abuse doesn't stand any chance of getting out of control.
Posted by Noa on February 11, 2000, at 5:12:20
In reply to Re: Mood stabilizers for Unipola.....Patty G/Karen, posted by JohnL on February 11, 2000, at 2:43:46
The ADs make me more fidgety than the Ritalin. And, the ritalin has worn off by bedtime.
Posted by saint james on February 11, 2000, at 11:59:42
In reply to Re: Stimulant, posted by Karen on February 10, 2000, at 23:45:13
> I`m extremely leery about the idea of stimulants as I`m already very anxious--do some people find they help mood without making you wired, anxious and unable to sleep-stimulating AD`s like prozac do this to me, so I imagine actual stimulants would be even worse.
James here....
DOSAGE ! One is trying to make someone well not a speed freak so the correct dose doesn't cause the negative symptoms you mention. Also stims make AD's work better.
james
Posted by Noa on February 11, 2000, at 13:37:03
In reply to Re: Stimulant, posted by saint james on February 11, 2000, at 11:59:42
As many have suggested on this board...start low, go slow. Start at a very low dose, titrate up very gradually, both in terms of the size of the step increase and the frequency of the step increases.
Posted by Lee on March 12, 2000, at 19:05:07
In reply to Re: Mood stabilizers for Unipolar Depression, posted by JohnL on February 9, 2000, at 5:13:38
> Karen,
>
> I think a flaw in general psychiatry is the assumption that an antidepressant should fix depression. And that if one doesn't, another will. This just isn't so in some cases, as I understand it. The reason is because there are many different malfunctions that can cause depression, just as there are many different things that can cause diarrhea, right? Antidepressants won't always target whatever problem is causing the depressive symptoms. And thus multiple failures on antidpressants.
>
> I know a woman who finally found total cure on just Depakote, after failing just about every other drug for 20 years. Ironically, Depakote can make a significant number of other people more depressed. A regular poster we used to see here a lot found total cure with Naltrexone, after decades of failing everything else including ECT. I know a woman who experienced total cure on her very first day of Wellbutrin. As I've said in other posts, and I have come to believe strongly, it all depends on how a particular drug target's the person's unique underlying problem.
>
> The farther a drug is away from targeting the problem, the longer it will take to have a trickle down effect and work, if it ever works at all. The closer the drug, the faster the results with fewer side effects. It is common to get worse on the wrong drug. It would seem apparent with you that raising serotonin and/or norepinephrine does not target the underlying problem. If it did, you would have responded to an AD by now.
>
> So looking at the mood stabilizers makes logical sense. Maybe one of those will target the underlying problem that so far has been missed. But I think there are even better choices for you at this point. It doesn't matter what the actual diagnosis of symptoms is. Some people with unipolar depression for example have found total cure with Lamictal, which is used in epilepsy and bipolar. I believe medication reactions provide important clues to guide treatment. The clues your history suggest are to stay away from antidepressants and focus instead on other psychiatric drug classes.
>
> You sound like a classic case of someone who would respond nicely to a psychostimulant, the same drugs used in ADD or ADHD. Even if you have no symptoms at all of ADD or ADHD, you fit the profile very nicely of someone who will respond to a stimulant. If so, the underlying problem would be NE/dopamine failure, which no antidepressant will fix. But a stimulant will. Like all drugs, if one isn't a best fit, another likely will be. Sometimes stimulants overcompensate and require a small dose of an antipsychotic as well to counterbalance. But doesn't it make sense that if all those antidepressants didn't work, we're barking up the wrong tree? The answer might be something as simple as a child's dose of Ritalin with a tiny dose of Zyprexa. Simple and fast. If a stimulant is going to work, it will do so in 24 to 72 hours. No long wait to find out. They will quickly replace or mimic the failed brain chemicals.
>
> If you respond negatively or neutrally to several stimulant trials, then the mood stabilizers would be the next logical place to look. In your shoes (actually I AM in your shoes) I think the stimulant class should be at the top of your priority list. No ADD or ADHD symptoms needed. With a history almost identical to yours, I responded robustly to Ritalin. Now I just need to explore the alternatives in that class to find a best fit and fine-tune dosing. Stimulants first, with a possible tiny adjunctive dose of an antipsychotic. Mood stabilizers second. That's what I would do if I were you. To hell with the antidepressants. You already know all to well they don't work for you. There are important clues in all those antidepressant failures. JohnLJohn & Karen-who is yr doc & what state R U from?
I am thinking of switching-Lee. Please write back Liverty31@AOL.com
Posted by Lee#2 on March 12, 2000, at 19:41:50
In reply to Re: Stimulant, posted by Noa on February 10, 2000, at 8:12:02
> It was my doc's suggestion, too. I was not getting enough AD response at the doses I tolerated, so he suggested ritalin to augment. It seemed really apt, too, since I had a lot of fatigue, which we later found out to be the result of sleep apnea. Even after the fatigue was controlled by treating the apnea (cpap machine), he wanted me to stay on the ritalin cuz it worked.
Noa-who's yr doc & what state R U from? Am thinking of switching. Always lethargic & down & doc won't prescribe stims.Write back pleaseLiverty31@AOL.com
Posted by Janice on March 12, 2000, at 22:09:24
In reply to Re: Stimulant, posted by Lee#2 on March 12, 2000, at 19:57:41
your posting's out-a-control! I'm joking (of course).
Sounds like you are unhappy with your doctor and need a new one. I'm not from the States, but maybe if you post where you're from, someone may know a doctor in your area.
I know it's very frustrating when you feel lousy, and your doctor is hesitant to give you a medication that you feel will help you.
From reading other people's postings over the past few months, it seems it's not that uncommon for a doctor to be hesitant about prescribing a stimulant. But many will...and if you are suitable for taking stimulants, you should be able to find a doctor that will prescribe it for you.
good luck in your search for a doctor, Janice.
Posted by JohnL on March 15, 2000, at 2:26:51
In reply to Re: Mood stabilizers for Unipolar Depression, posted by Lee on March 12, 2000, at 19:05:07
> John & Karen-who is yr doc & what state R U from?
> I am thinking of switching-Lee. Please write back Liverty31@AOL.comWould you believe, my psychiatrist's name is Dr Katz? Yep. Up in Portland, Maine. He is head of psychiatry at a major HMO here, and also commutes to Connecticut a couple days a week as head of psychiatry at a hospital there. He's an oldtimer with wonderful bedside manners and a very open mind. He's willing to try anything, as long as it isn't dangerous. He even lets me make all the suggestions if I want, take total control, or he'll offer his own...whichever I'm more comfortable with. He treats me as a unique individual, which we all are. No blanket strategies in his practice. I think you should consider finding a new doctor. Stimulants and maybe other drugs your doctor objects to are important weapons in the arsenal. I don't think you should be denied the opportunity to at least try them and compare them in a probing sort of way.
This is the end of the thread.
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