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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 Gerry S. on June 20, 2001, at 9:29:23
I am depressed. Over the past year I responded well to Remeron for 6 months. It wasn't great, so I thought we'd try another AD. In the past 6 months I have gone through Paxil, Luvox, and Serzone. The side effects of (e.g. crushing daytime anxiety on Paxil) outweighed the benefits.
My doctor has now suggested that the best option is ECT. My problem is that I am scared of AD's because they have beaten me down, so I don't feel strong to deal with another set of horrible side effects. On the other hand, ECT seems so extreme. Help me.
Posted by manowar on June 20, 2001, at 10:37:33
In reply to Help! ECT has been recommended, posted by Gerry S. on June 20, 2001, at 9:29:23
I had the same kind of problems with SSRIs (Paxil, prozac, ect.). Actually every drug that acts on serotonin has given me terrible side effects with no relief. Has your doctor considered TCAs (tricyclic anti-depressants) or MAOIs yet? You may want to get a second opinion before doing that. Hang in there.
Posted by Chris A. on June 20, 2001, at 11:00:59
In reply to Re: Help! ECT has been recommended, posted by manowar on June 20, 2001, at 10:37:33
Gerry,
There are lots of meds out there to try, but ECT is generally very effective in the short term.
The main side effects are cognitive impairment, especially experienced as memory loss. As a result of my experience I would suggest requesting comprehensive neuropsych testing prior to proceeding. Why? Because any previous damage to the brain predicts a greater risk of these side effects. For example, if it is apparent that someone already has cognitive impairment that follows the pattern commonly found in epilepsy or head injury, then ECT is not the best choice.
Those have received ECT also tend to relapse, so continuation with meds afterwards is recommended to maintain any benefit.
It is scary to contemplate and it is normal to be anxious about it. I found the procedure to be a piece of cake. The long term side effects have been another matter. I had about fifty treatments over the course of 24 years, both bilateral and unilateral.
I hope this helps and that you find relief very soon.Blessings,
Chris A.
Posted by AMenz on June 20, 2001, at 11:18:26
In reply to Re: Help! ECT has been recommended, posted by manowar on June 20, 2001, at 10:37:33
I agree with Manowar. The SSRI's may be not the drug of choice for you. MAOI and TCA are a possibility. So is treating the anxiety with an anxiolytic. These are questions to pose to your doctor.
I also empathize with you reluctance to try new meds I am in the same boat.
I had a wonderful experience with SSRI's two weeks of the month. The other two weeks they set off a terrible mixed state. But when I backed off the SSRI's anxiety set in. Lorezapam, Klonopin, Buspar are all choices for anxiety. Did the anxiety predate the depression. Is it a separate disorder or part of the depressive state?
You should get a second opinion if your doctor has only this one strategy you are reluctant to follow.
> I had the same kind of problems with SSRIs (Paxil, prozac, ect.). Actually every drug that acts on serotonin has given me terrible side effects with no relief. Has your doctor considered TCAs (tricyclic anti-depressants) or MAOIs yet? You may want to get a second opinion before doing that. Hang in there.
Posted by Gerry S. on June 20, 2001, at 11:47:34
In reply to Re: Help! ECT has been recommended, posted by AMenz on June 20, 2001, at 11:18:26
First, thanks all for the encouragement.
The answer is "no" I have not tried any TCA's or MAOI's. All I have tried is Remeron (4 months), Paxil (8 weeks), Luvox (briefly coming off paxil to see if it would alleviate the anxiety), and Serzone (about 6 weeks or so). He was thinking about me trying effexor but, perhaps due to my fears about new meds and my mental deterioration, I suspect he felt backed into a corner--thus the ECT option as his main advice.
On anxiety. I have always had some anxiety, but it was tolerable. It just took off a few weeks into Paxil and basically, while fluctuating, has never gone away. The doc gave me Xanax but it just seems to me like an inefficient way to combat persistent anxiety (i.e. 24/7), and so I have been reluctant to use it much.
The bottom line is I now feel like I have "depression-plus". I am completely non-functioning in work and life.
Thanks again for the kind words of encouragement.
Posted by Sulpicia on June 20, 2001, at 21:26:52
In reply to Re: Help! ECT has been recommended, posted by Gerry S. on June 20, 2001, at 11:47:34
> Hi Gerry,
while ECT can be very effective, from your posts it really doesn't
seem like your pdoc has done very much at all, as far as dealing with
your depression -- of course if you're on the brink of hell or suicide,
more med trials begin to be questionable.
TCAs definately but did the pdoc try any augment combos? I wouldn't desert
the SSRIs w/out this, preferably exploring a welbutrin/prozac combo.
Stimulant are another good augment but your anxiety could rule this out.
There are literally TONS of options to try -- I could write for several
hours.
On the links at this site are several depression treatment algorithms:
look at 1 or 2 so you understand what your treatment should/might look like.
I really hate to ask this, but how much psychopharmacology experience
does your pdoc have?
He hasn't even begun to exhaust the possibilities -- at all.
How high did he go on dosages?
S.
Posted by SalArmy4me on June 21, 2001, at 1:02:21
In reply to Help! ECT has been recommended, posted by Gerry S. on June 20, 2001, at 9:29:23
Posted by Anna Laura on June 21, 2001, at 2:19:31
In reply to Re: Help! ECT has been recommended, posted by Gerry S. on June 20, 2001, at 11:47:34
> First, thanks all for the encouragement.
>
> The answer is "no" I have not tried any TCA's or MAOI's. All I have tried is Remeron (4 months), Paxil (8 weeks), Luvox (briefly coming off paxil to see if it would alleviate the anxiety), and Serzone (about 6 weeks or so). He was thinking about me trying effexor but, perhaps due to my fears about new meds and my mental deterioration, I suspect he felt backed into a corner--thus the ECT option as his main advice.
>
> On anxiety. I have always had some anxiety, but it was tolerable. It just took off a few weeks into Paxil and basically, while fluctuating, has never gone away. The doc gave me Xanax but it just seems to me like an inefficient way to combat persistent anxiety (i.e. 24/7), and so I have been reluctant to use it much.
>
> The bottom line is I now feel like I have "depression-plus". I am completely non-functioning in work and life.
>
> Thanks again for the kind words of encouragement.
Jerry please give TCA a try!! I had a second bout of depression last winter : i was getting psychotic i mean totally insane, not eating, not moving from the couch, major memory losses (i was getting lost in the middle of the street not being able to find my way back (just like Alzheimer disease sufferers ) delirious thinking : Tofranil (imipramine) saved my life, please give the TCA a try, i think it's worth it; the first weeks might be pure hell, but there is a high chance they might be working for people with major psychotic depression.
Hang in there!!!!Best wishes and a hug
Anna Laura
Posted by SalArmy4me on June 21, 2001, at 4:20:55
In reply to Help! ECT has been recommended, posted by Gerry S. on June 20, 2001, at 9:29:23
Before you give up on non-invasive treatment, there is hope for you in newer medications and newer combinations. I found relief in the antipsychotic Ziprasidone (http://www.medsafe.govt.nz/Profs/datasheet/z/zeldoxcap.htm). Here are some more options that you may not have thought of:
Nefazodone - great for sleep; no sexual dysfunction; no anticholinergics side-effects.
Lamotrigine - good side-effect profile; most antidepressant properties of the anticonvulsants.
Carbamazepine - less side effects than Lithium or divalproex sodium.
Topiramate - the newest mood-stabilizer; it promotes weight loss.
Desipramine - the least side-effects of all the Tricyclics; one of the few NRIs except for reboxetine.
High-dose Venlafaxine - at higher doses Venlafaxine affects more chemicals than SSRIs.
Buspirone - an effective antidepressant and anxiolytic at high doses (60-90mg).
Dopamine Agonists - Pramipexole has two studies on it (I took it).
"Power Combinations" - Remeron+Effexor; Wellbutrin+Remeron, Remeron + Prozac.
Augmentation of anything you have tried before with Lithium, Pindolol, or Buspar (I took pindolol).
Foreign medications to the US: the RIMA Moclobemide; Reboxetine; Amisulpride, etc.
Atypical Neuroleptics/Antipsychotics with antidepressant properties: Risperidone, Olanzapine, Seroquel, ZIPRASIDONE
Provigil - a stimulant that is possibly effective.
Irreversable MAOIs - Phenelzine, Tranylcypromine. Extremely Effective.
MAOI-B - Selegiline, an antidepressant almost comparable to Phenelzine at 60 mg.
I hope that gives you hope!
Posted by rmshed on June 23, 2001, at 22:50:36
In reply to Help! ECT has been recommended, posted by Gerry S. on June 20, 2001, at 9:29:23
> I am depressed. Over the past year I responded well to Remeron for 6 months. It wasn't great, so I thought we'd try another AD. In the past 6 months I have gone through Paxil, Luvox, and Serzone. The side effects of (e.g. crushing daytime anxiety on Paxil) outweighed the benefits.
>
> My doctor has now suggested that the best option is ECT. My problem is that I am scared of AD's because they have beaten me down, so I don't feel strong to deal with another set of horrible side effects. On the other hand, ECT seems so extreme. Help me.
My father received 13 treatments and today he is a different man. He needs to take 20 mg of prozac a day, but besides that he has been in good spirits for the last 5 years. My father was very fortunate that he didn't really loose much of his memory and the treatments seem to eliminate his depression. He attempted to kill himself and had hit rock bottom. He was hospitalized for more than a month. I visited him daily and supported him through a very hard time. I am so happy for him. Without the treatments, the family might have had to have him committed. I have even thought about taking the treatments in the future. Of course, I would only take the treatments if there were no other options. I look at what options there are when you no longer respond to drug therapy, not much. I think that there are alot of misleading information out on ECT. I am sure that the stories you read are true, but I think it can be an effective treatment for some. Having a good team of doctors to monitor you during the process would be a great comfort.
This is the end of the thread.
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