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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Carolyn on February 11, 2000, at 17:54:47
I have been moderately depressed for about two months.
It seems to be getting worse, rather than better. I think I am suffering from SSRI poop-out, but so far my doctor has just tried higher doses of same med (which did work for several years) and the addition of klonipin. In previous depressive episodes I have cut myself, and resorted to alcohol. Now I am having these same urges. Can anyone give me tips on how to deal with that until I am feeling better? Just don't doesn't help. Thanks!
Posted by Noa on February 11, 2000, at 18:53:41
In reply to Bad solutions, posted by Carolyn on February 11, 2000, at 17:54:47
> C, I am sorry you are feeling depressed. Is it time to try a different medication?
Posted by Carolyn on February 11, 2000, at 19:18:48
In reply to Re: Bad solutions, posted by Noa on February 11, 2000, at 18:53:41
> > C, I am sorry you are feeling depressed. Is it time to try a different medication?
Noa...yes, I think so. But try convincing a doctor you know more than he does! I do have a very reputable doctor, who has been very good at prescribing medications in the past. Maybe I am just too impatient. I'm having a lot of difficulty working. Also have a 15 year old who needs attention,and I am pretty much feeling a failure at that right now. And mostly I am just feeling desperate to stop the pain. Suicide doesn't seem an option...so temporary unconsciousness via alcohol or tranquilizers seems preferable. Even cutting...physical pain to take my mind of the mental pain. I really don't want to do any of these things, but the urge is so strong.
Posted by Cass on February 11, 2000, at 21:28:34
In reply to Re: Bad solutions, posted by Carolyn on February 11, 2000, at 19:18:48
Hi Carolyn,
Did you tell your doctor about your urges to cut and drink? Perhaps if he knew he would be more willing to try a different med. In the meantime, I know things are hard for you. Try forgetting about yourself by doing something less harmful, i.e. music, movies? I hope it isn't too simplistic, but movies can be a great escape. Well wishes.
Cass
Posted by michael on February 11, 2000, at 22:26:21
In reply to Re: Bad solutions, posted by Cass on February 11, 2000, at 21:28:34
> Hi Carolyn,
> Did you tell your doctor about your urges to cut and drink? Perhaps if he knew he would be more willing to try a different med. In the meantime, I know things are hard for you. Try forgetting about yourself by doing something less harmful, i.e. music, movies? I hope it isn't too simplistic, but movies can be a great escape. Well wishes.
> CassI agree w/Cass - make sure your doc knows what's going on with you! If he knows where you're at, hopefully he'll be a bit more open-minded...?
Good Luck, and hang in there!
michael
Posted by Carolyn on February 11, 2000, at 23:07:19
In reply to Re: Bad solutions, posted by michael on February 11, 2000, at 22:26:21
> > Hi Carolyn,
> > Did you tell your doctor about your urges to cut and drink? Perhaps if he knew he would be more willing to try a different med. In the meantime, I know things are hard for you. Try forgetting about yourself by doing something less harmful, i.e. music, movies? I hope it isn't too simplistic, but movies can be a great escape. Well wishes.
> > Cass
>
> I agree w/Cass - make sure your doc knows what's going on with you! If he knows where you're at, hopefully he'll be a bit more open-minded...?
> Good Luck, and hang in there!
> michael
No,I haven't been very good at communicating with my doctor, I guess. I tend to minimize a bit. My mother suffered from depression when I was young...before depression was well understood. I remember she was always accused of "just wanting attention" or "making things up". So I tend to fear doing the same thing. Especially since, as is typical I know, I feel better in the evening. Then I wonder if I am imagining the whole thing.
Talk about a merry-go-round. I will try to do better at being honest with the doctor. Thanks so much for your support. This web site is great...helps you remember you are not alone, and you are not crazy! I also struggle a great deal with guilt...guilt about causing worry for others, especially my husband, and guilt about not accomplishing as much as I usually do. I know this is "normal", but still a problem for me. Hope you are succeeding in your own struggles. On a positive note, I had a friend say what a shame I had to go through all this. I responded...well, if not me, who should have to go through this! My answer to the "why me" question! I would also be interested in hearing from anyone who has trouble dealing with faith issues when depressed. I am fortunate to belong to a supportive church, but have had some bad experiences over the years with well-meaning but ill-informed folks who have the attitude that lack of faith is a cause of depression. Thanks again.
Posted by JohnL on February 12, 2000, at 5:05:20
In reply to Bad solutions, posted by Carolyn on February 11, 2000, at 17:54:47
> I have been moderately depressed for about two months.
> It seems to be getting worse, rather than better. I think I am suffering from SSRI poop-out, but so far my doctor has just tried higher doses of same med (which did work for several years) and the addition of klonipin. In previous depressive episodes I have cut myself, and resorted to alcohol. Now I am having these same urges. Can anyone give me tips on how to deal with that until I am feeling better? Just don't doesn't help. Thanks!
Hi Carolyn. I just wanted to say that I agree with everyone else so far that it is time to communicate thoroughly with the doctor and to try another drug. The typical approach is to prescribe you a different drug from the SSRI class for a 6 week trial. A more novel approach is to try two or three quickly (rather than the drawn-out 6 week trials) to find a best fit. Very often we all have a favorite within the SSRI class. A favorite is recognized by: quick response (often in just days if it is hitting bullseye), few side effects, and a general feeling that we instinctively know it's the right one (again, related to good quick response). The longer it takes and the worse the side effects, the farther we are from targeting the underlying chemical imbalance.One SSRI may work wonders while the others didn't. A long trickle down effect is common when the drug isn't a best fit. It may work in time, or maybe never at all. But the best-fit-drug will usually work fast. You'll know it when it happens. With this in mind, you might try to sell your doc on the idea of trying each of two or three other SSRIs (including Effexor) for two weeks each, with a day or two washout inbetween. Get small sample prescriptions for three. The idea is to find the best fit as quickly as possible. Once a best fit has been found, then we can continue with increased time and dose. The best fit is usually obvious within days. If response in two weeks is neutral or negative, move to the next one. Even if response is good, another might be even better. After trying them all, go back to your favorite. Start with the shortest half-life drug first (Effexor) and go from there. This is a different approach than most doctors practice, but it makes perfect sense to me to look for that best fit before committing to longer term trials. Just a different way to get to the same end result, except a lot faster. In the event that none of the SSRIs are helpful, then the same procedure can be done in other classes of psychiatric drugs. A best fit does indeed exist. You'll know it quickly when it's found. I'm on the sidelines cheering for ya. Hang in there. JohnL
Posted by Noa on February 12, 2000, at 8:31:55
In reply to Re: Bad solutions, posted by JohnL on February 12, 2000, at 5:05:20
Carolyn, you mentioned a teenager. Are you absorbing his feelings?
Can you get help dealing with him? Support?
Posted by Carolyn on February 12, 2000, at 11:22:02
In reply to Re: Bad solutions, posted by Noa on February 12, 2000, at 8:31:55
> Carolyn, you mentioned a teenager. Are you absorbing his feelings?
>
> Can you get help dealing with him? Support?John...Thanks for the advice. I am to talk to the doc Monday. Will try to bring up your suggestion, although I am not good at taking control...tend to think of the doctor as "god".
Noa...I talked to the doctor at length about our teen...we are adopting him, and he does have many problems, but the doctor feels, as do I, that this is not really relevant to my depression. Brandon is a real bright spot in my life. And my depression has always been cyclical...seems to re-appear independently of circumstance since the first couple episodes. But thanks for caring!
Posted by PattyG on February 12, 2000, at 13:45:52
In reply to Bad solutions, posted by Carolyn on February 11, 2000, at 17:54:47
If you have been on lots of AD's and truly feel you're suffering from SSRI "poop out," wouldn't it be possible to try Naltrexone? Given your urges to drink and/or cut, I would say that might be something to think about? Good luck.
Posted by jd on February 13, 2000, at 4:13:13
In reply to Re: Bad solutions, posted by PattyG on February 12, 2000, at 13:45:52
Carolyn,
I was just about to respond with the same advice as Patty below, then I saw her post. I definitely second her idea that naltrexone might be worth trying as an add-on to your SSRI if you're experiencing "poop-out" along with a desire to drink and self-cut. Since naltrexone is often helpful for all three of these things individually (i.e., poop-out, alcohol cravings, and self-cutting), it stands to reason that it might well be worth a try in your particular case. See the other threads in this vein during the last several weeks--they point to more naltrexone information on this board and on the "tips" part of the site. It's certainly not the only thing to try, but I would certainly try it before giving up on SSRIs completely!
Best to you,
jd> If you have been on lots of AD's and truly feel you're suffering from SSRI "poop out," wouldn't it be possible to try Naltrexone? Given your urges to drink and/or cut, I would say that might be something to think about? Good luck.
This is the end of the thread.
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