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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 zarathustra on January 7, 2002, at 21:39:56
I have been on divalproex-sodium for 2 months now. Iam currently at 2000mgs a day, and have noticed nothing (except ten pounds). Should I be questioning the 'current' diagnosis, or suggesting a different AED?
I want to try lithium, but no doctor will let me, they say that the side effect profile is bad: I can handle side effects if the damn depression would lift!I have tried all of the ssri (paxil and zoloft used to work excellently years ago) wellbutrin, effexor, serzone, menerix.
Maybe Nardil or Parnate? I am ready to give up, my pdoc has got it in his little head that I am bipolar; I think not.
I just need my memory back, and some emotion or 'color' in my life, I only seem to ever find that colour when I am drinking (not often) or hung over.
Why did Paxil and Zoloft fail to work after restarting them months later? They changed my life I felt sooo good, so alive, I had goals I had energy, enthusiasum, I felt good about myself I held my head up high.......
but, I stopped them naively due to the sexual side effects and the thought that I was 'cured'. I would gladly make the trade off now!
The last time I tried Paxil, I was up to 60mgs a day for five months: no response, not even loss of sex drive. Did my brain become tolerant to them?Anyone in the know, please respond.
Andrew.
Posted by bob on January 7, 2002, at 23:20:14
In reply to S.S.R.I. tolerance and other stuff., posted by zarathustra on January 7, 2002, at 21:39:56
I find it interesting that the doctors you've talked to say the side-effect profile of lithium is intolerable. I got a professional consultation done at Hopkins and they pushed Lithium. They said for for many people "it's not worse than taking sugar pills." Yeah... RIGHT! I don't know where they get stuff like that.
Anyway, I took Depakote for almost two years, and couldn't handle it without a hefty dose of Welbutrin to keep me awake (I still was drowsy a lot and had to sleep about 10 hrs/day). My opinion is that mood stabilizers are MUCH better at preventing mania, than they are at preventing lows. They may prevent an all out nasty unipolar depressive episode, but if they do indeed stabilize, it is at a relatively low mood point -- at least for me. I hardly did anything of consequence when I was on Depakote. I layed on the couch, with no enthusiasm, no goals, and no desire. It was a rather good anxiolytic though.
Posted by Mitch on January 7, 2002, at 23:56:40
In reply to S.S.R.I. tolerance and other stuff., posted by zarathustra on January 7, 2002, at 21:39:56
> I have been on divalproex-sodium for 2 months now. Iam currently at 2000mgs a day, and have noticed nothing (except ten pounds). Should I be questioning the 'current' diagnosis, or suggesting a different AED?
> I want to try lithium, but no doctor will let me, they say that the side effect profile is bad: I can handle side effects if the damn depression would lift!Wow, you got to 2G of divalproex and no help with depression? No wonder nothing will touch it. I would strongly suggest a cross-taper of the Depakote with Lithium and see what happens. i.e.-drop the Dep to 1.5G and add 300mg of lithium for a week, etc. It is possible that a combo-say 500mg of Depakote+600mg of Lithium might be just right.
Mitch
Posted by bob on January 7, 2002, at 23:58:38
In reply to Re: S.S.R.I. tolerance and other stuff. » zarathustra, posted by Mitch on January 7, 2002, at 23:56:40
Mitch:
Have you personally found Divalproex Sodium to have a robust antidepressant quality?
Posted by Mitch on January 8, 2002, at 0:50:09
In reply to Re: S.S.R.I. tolerance and other stuff. » Mitch, posted by bob on January 7, 2002, at 23:58:38
> Mitch:
>
> Have you personally found Divalproex Sodium to have a robust antidepressant quality?Nope,
I have just heard others mention that *they* had an AD response at high doses-and relayed that information. I think they were BPI and needed the high dose Depakote to prevent mania and happened to discover an antidepressant effect at that dosage. The first time I tried it the only other mood stabilizer I ever was on was Lithium. I cross-tapered the lithium to Depakote and my depression got worse. No doubt about it. What Depakote did for me (with a BPII, ADHD dx)was help me sleep and reduced mixed-state anxiety. I still got grouchy on it (I call it "sullen"-that is the best description), but there wasn't any hypomania thrown in. I felt like picking fights with people-I just wasn't excited about it (a depressive sort of "if I can't kick your ass-you will kick mine-so what" kind of feeling/thinking). It affects GABA significantly and other "GABA-ergic" mood stabilizers (i.e.-Topamax) and diazepam could make me quite hostile, sullen, or indifferent. I attribute that to my ADHD (it tends to worsen it).
Mitch
Posted by bob on January 8, 2002, at 14:30:35
In reply to Re: S.S.R.I. tolerance and other stuff. » bob, posted by Mitch on January 8, 2002, at 0:50:09
How does Lithium work for you? Are you on it now?
Posted by Mitch on January 8, 2002, at 23:43:19
In reply to Re: S.S.R.I. tolerance and other stuff. » Mitch, posted by bob on January 8, 2002, at 14:30:35
> How does Lithium work for you? Are you on it now?
Hi Bob,I was on Lithium for nearly twenty years. I am not on it now (not since 1998). It has worked reasonably well as monotherapy. I probably would be dead now if it had not been around. The biggest trouble I had with it was severely aggravated diarrhea (irritable bowel). That resulted in bad non-compliance-I didn't want to take something which made me dart out of classrooms unexpectedly, etc. It also didn't solve the fatigue and hypersomnia associated with my seasonal major depressions and my comorbid ADHD. Neurontin was as good as lithium as an antidepressant for me and didn't upset my stomach, it helps with my ADHD (which Lithium didn't do much for). The trouble is that Neurontin isn't as good an antimanic agent as Li is. What I need now to complete the "puzzle" is an antimanic agent (for about half the year) that I can tolerate (and Depakote worsens my ADHD). So that is the newest problem to solve.
Mitch
Posted by bob on January 8, 2002, at 23:47:00
In reply to Re: S.S.R.I. tolerance and other stuff. » bob, posted by Mitch on January 8, 2002, at 23:43:19
I know what you mean when you say you might not be here now if it weren't for the meds. So, for you, Lithium caused a lot of drowsiness?
Are you saying that as a mood stabilizer, Neurontin is better at controlling the lows than the highs?
Posted by bob on January 9, 2002, at 0:37:47
In reply to Re: S.S.R.I. tolerance and other stuff. » bob, posted by Mitch on January 8, 2002, at 23:43:19
Mitch:
Did Lithium pack on the pounds?
Posted by Mitch on January 9, 2002, at 10:50:52
In reply to Re: S.S.R.I. tolerance and other stuff. » Mitch, posted by bob on January 8, 2002, at 23:47:00
> I know what you mean when you say you might not be here now if it weren't for the meds. So, for you, Lithium caused a lot of drowsiness?
>
> Are you saying that as a mood stabilizer, Neurontin is better at controlling the lows than the highs?In short, yes.
If I rank Dep, Li, and Neurontin in terms of antidepressant effect... The Neurontin (yes-is better) would be first, with lithium a close second and Depakote a distant last. I have considered a Neurontin+Lithium combo if need be. If the Li didn't churn my guts to shreds...
Oh, yes I did gain weight on lithium, but not as much as with Depakote. The lithium didn't produce as much drowsiness/tiredness as Depakote either. Unfortunately, the lithium produced a transient high blood calcium level (hypercalcemia).
Mitch
Posted by Denise528 on January 10, 2002, at 5:20:39
In reply to S.S.R.I. tolerance and other stuff., posted by zarathustra on January 7, 2002, at 21:39:56
> Hello,
I know exactly what you mean about the Antidepressants not working after starting them again, I've had exactly the same problem. I was on Seroxat about 5 years ago and felt great, had more energy, motivation etc. I too came off them thinking that if I ever got depressed again it would be simple just go back on the Seroxat and everything will be hunky dory. Only it hastn't worked out like that at all, the effects have been devastating. They haven't worked at all, if anything they have made me feel worse, I might as well be swalling smarties. Sometimes I really feel at the end of my tether but I keep telling myself that if they can transplant Pigs organs into human beings then surely they can find a drug that works for me. The only thing that has helped me is the Zyprexa but sometimes this makes me feel like I haven't any emotions at all.
I really believe that they should put a warning on the medication literature advising you that if you discontinue the drug it is not liable to work the next time around. I wish somebody could tell me why they don't work second/third time around, I then might be able to work out what would work.
Let me know how you get on, I'd be really interested to know if you find anything that helps as it might give me some hope.
Denise
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