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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by ryan_s on February 15, 2000, at 2:23:25
i have been severly depressed for two years now. i am only twenty two and am looking for a way out so i can get my life started in the right direction. at the present time i find it hard to hold a conversation with friends, find it hard to get close to girls (really want a girlfriend), and find it hard to wake up in the morning with motivation and drive. antidepressants have not helped me in the past. paxil, buspar, prozac, wellbutrin, neurontin, zyprexa, celexa, and seroqeul have not helped with the symptoms of my depression. next on my agenda is the use of an maoi inhibitor. there is one problem with using maois, that is my pdoc will not perscribe me this class of antidepressants in fear of liability. this makes me extremely frustrated. i am about to call local pdocs and ask if they perscribe maoi's. for all of those reading this message, do you think this is the right approach by asking a question or is there another means of abtaining an maoi. please help! thanks. ryan
Posted by S. Suggs on February 15, 2000, at 5:08:41
In reply to help help my ship is sinking, posted by ryan_s on February 15, 2000, at 2:23:25
Yes it is the right approach. If your doc will not prescribe a maoi, in light of your trials on other meds, it would warrant doing so. I take parnate and have done so for 4 months or so. So far it has done better than a whole list I tried for 5 years. If he/she will not do it, go elsewhere. Go back and search the post on maoi's and you will find some good info.
Best of luck and blessings,
S. Suggs
Posted by Cam W. on February 15, 2000, at 23:04:53
In reply to Re: help help my ship is sinking, posted by S. Suggs on February 15, 2000, at 5:08:41
> Yes it is the right approach. If your doc will not prescribe a maoi, in light of your trials on other meds, it would warrant doing so. I take parnate and have done so for 4 months or so. So far it has done better than a whole list I tried for 5 years. If he/she will not do it, go elsewhere. Go back and search the post on maoi's and you will find some good info.
>
> Best of luck and blessings,
>
> S. SuggsRyan - Since you are running the gamut of antidepressants, maybe ask your doctor about ECT. It is not the scary procedure portrayed in Hollywood movies and is very effective in refractory depression. It is the treatment of choice for depression in pregnant women and in the elderly over 75 years. You can get some amnesia, but this usually resolves fairly quickly. ECT is a safe and very effective treatment (the best antidepressant we have). Most people need 6 to 10 treatments with follow-ups at about six weeks intervals for the severely depressed. Ask your doctor, it may be worth a try. S.Suggs is right about MAOIs, but I find them to be a pain in the butt with all their restrictions and potentially serious side effects, although they do work in many refractory depressions. Hope this helps. Cam W.
Posted by JohnL on February 16, 2000, at 4:47:07
In reply to help help my ship is sinking, posted by ryan_s on February 15, 2000, at 2:23:25
In my book it's perfectly fine--actually a requirement--to screen potential pdocs with particular questions, like whether they would consider prescribing you an MAOI, a stimulant, or whatever. No sense in doing business with a doc who won't cooperate with your wishes. After all, who pays who? In my experience the best docs were the ones that welcomed patient involvement. It gives a sense of ownership in one's own treatment. We are already handicapped as it is. We don't need to be further handicapped by restricting possible treatments.
In your particular case though, there are a couple things you could try before the MAOI route. One is Desipramine, or Nortriptyline. These ADs will target different chemical imbalances than anything you've tried yet.
Another good possibility, in my mind, would be to choose your favorite SSRI so far, get back on a small dose, and try three different stimulants one at a time in short trials added to the SSRI. This combo can work wonders. I read somewhere that 80% of people who respond to ECT also respond equally well to stimulants. And stimulants work fast. Days, not weeks or months. With these things in mind, this might be the place to start next. SSRI + stimulant. If that either doesn't work or makes you worse, then backup and try Desipramine or Nortriptyline. If still no results, then finally the time has come to try an MAOI. Just my thoughts. But nothing is going to work very well if the doctor limits approaches in getting you well. You need a doc who will be comfortable using all available ammunition to battle the beast.
Posted by saint james on February 17, 2000, at 0:46:42
In reply to help help my ship is sinking, posted by ryan_s on February 15, 2000, at 2:23:25
> i have been severly depressed for two years now. i am only twenty two and am looking for a way out so i can get my life started in the right direction. at the present time i find it hard to hold a conversation with friends, find it hard to get close to girls (really want a girlfriend), and find it hard to wake up in the morning with motivation and drive. antidepressants have not helped me in the past. paxil, buspar, prozac, wellbutrin, neurontin, zyprexa, celexa, and seroqeul have not helped with the symptoms of my depression. next on my agenda is the use of an maoi inhibitor. there is one problem with using maois, that is my pdoc will not perscribe me this class of antidepressants in fear of liability. this makes me extremely frustrated. i am about to call local pdocs and ask if they perscribe maoi's. for all of those reading this message, do you think this is the right approach by asking a question or is there another means of abtaining an maoi. please help! thanks. ryan
James here.....7 AD's with none tried in combo? No TCA's? You have not even begun to to try all the psooibilities not including MAOI. Could you tell us about doses and how long you took them ? In general your doc sounds like you need another. I think you should try the many other AD's (there are 15-20 in addition to what you have tried) plus try combos (more than 1 at a time) b4 you go to MAOI or ECT.
It does not bode well that your doc says he does not use MAOI's, a well seasoned doc would say that they use them on a few patients when nothing else works.
james
Posted by bob on February 17, 2000, at 15:53:02
In reply to Re: help help my ship is sinking, posted by JohnL on February 16, 2000, at 4:47:07
Good for you, Ryan, for being so proactive about this. I wish I had stuck things through at 22 instead of giving up for another twelve years before I got back into treatment. So, whatever the short term, stick with it and keep trying to work it out.
You mentioned a number of SSRIs -- apparently non-responders to SSRIs often respond well to TCAs and vice versa. Nortriptyline has done more for me in the long haul than zoloft, prozac, or paxil ever did, even with those SSRIs in cocktails. I've also had fewer side effects on nortrip than on any SSRI. Maybe it'll work for you as well.
Maybe some of the other folks on MAOIs can also fill you in on all the restrictions that come along with them. I haven't really followed the conversations on here closely, but what I've picked up on is that MAOI restrictions (like ECT's reputation) are a bit overblown. Certainly, trying a TCA or investigating some combination drug therapy would require less in terms of lifestyle changes (as if we all don't need some lifestyle changes anyway ;^) so you might want to check that out first.
Everyone's comments, tho, get down to the issue of what your pdoc has to offer. It sounds like "not much" may be the answer for your current pdoc. By all means, if you're not getting the care and attention you need, go shopping for another.
Hey folks, doesn't Dr. Bob have something about questions to ask a prospective pdoc, or was that somewhere else on the web?
stick in there, ryan
bob
Posted by Janet from Brazil on February 17, 2000, at 16:47:22
In reply to Re: help help my ship is sinking, posted by Cam W. on February 15, 2000, at 23:04:53
> > Yes it is the right approach. If your doc will not prescribe a maoi, in light of your trials on other meds, it would warrant doing so. I take parnate and have done so for 4 months or so. So far it has done better than a whole list I tried for 5 years. If he/she will not do it, go elsewhere. Go back and search the post on maoi's and you will find some good info.
> >
> > Best of luck and blessings,
> >
> > S. Suggs
>
> Ryan - Since you are running the gamut of antidepressants, maybe ask your doctor about ECT. It is not the scary procedure portrayed in Hollywood movies and is very effective in refractory depression. It is the treatment of choice for depression in pregnant women and in the elderly over 75 years. You can get some amnesia, but this usually resolves fairly quickly. ECT is a safe and very effective treatment (the best antidepressant we have). Most people need 6 to 10 treatments with follow-ups at about six weeks intervals for the severely depressed. Ask your doctor, it may be worth a try. S.Suggs is right about MAOIs, but I find them to be a pain in the butt with all their restrictions and potentially serious side effects, although they do work in many refractory depressions. Hope this helps. Cam W.I've been taking Parnate for 3 weeks. I haven't found the diet resrictions at all bothersome,but so far it has had no effect.So don't get your hopes up too high! Best Wishes Jan
Posted by torchgrl on February 18, 2000, at 0:22:23
In reply to Re: help help my ship is sinking, posted by bob on February 17, 2000, at 15:53:02
> Hey folks, doesn't Dr. Bob have something about questions to ask a prospective pdoc, or was that somewhere else on the web?
>
> stick in there, ryan
> bobI know that Ivan Goldberg has something on this at his Depression Central site...
This is the end of the thread.
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