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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by tb on April 19, 2002, at 15:03:55
Hey everyone,
I am really discouraged. I must be THE most treatment resistant person EVER. I have been suffering from bulimia for the last 12 years. I have been on EVERY AD out there - prozac, zoloft, wellbutrin, effexor, buspar, serzone, remeron, clomipromine, naltrexone. I've also tried topamax, adderall, ritalin, and dexedrine to help potentiate the drugs. NOTHING HELPS. I don't even get the bad side effects from drugs anymore.
I tried Topamax last week, full dose, and it didn't even make me tired let alone help with the binge eating.
Does anybody out there have any ideas of what route I should take. My pdoc is stumped...guess it's time to find a new one?
Thanks
Tb
Posted by renelso1 on April 19, 2002, at 15:35:31
In reply to Most treatment resistant person, ever..., posted by tb on April 19, 2002, at 15:03:55
are you combining therapy with your medications? friends of mine that have suffered from EDs were only able to overcome them (or rather manage them) with a combination. and maybe it is time to find a new doc. maybe one that explores more alternative forms of treatment since the current traditional ones don't seem to be effective...
just some thoughts, good luck!
Posted by tb on April 19, 2002, at 16:21:49
In reply to Re: Most treatment resistant person, ever..., posted by renelso1 on April 19, 2002, at 15:35:31
yes, I am in therapy. I've been in therapy longer than I've been on drug treatment. I'm trying out a new clinic that specializes in eating disorders. It's a full treatment center so we'll see how that goes.
Thanks
tb
Posted by katekite on April 19, 2002, at 16:59:29
In reply to Re: Most treatment resistant person, ever..., posted by tb on April 19, 2002, at 16:21:49
Don't give up.
Here's my list from the last 10 years: buspar, zoloft, prozac, paxil, celexa, valium, ativan, klonopin, remeron, trazodone, serzone, wellbutrin, moclobemide (ordered it from abroad even, it was easy, I highly recommend a trial if you haven't if your pdoc thinks highly of maois this one is mild and safer), neurontin, depakote, gabatril, lamictal, xyprexa, samE, nortriptyline, ritalin, I think that's it but there might be more.
Along the way I've found several that help some symptoms some of the time. I will eventually end up on a stimulant and probably an ssri and I'm very hopeful right now that I may actually end up having a good life, a job I like, a life I can enjoy, things are finally seeming they might fall into place, just this week (and no I'm not bipolar, this isn't a hypomanic yippee), LOL.
It can take forever to find the right combination but when you do you won't regret one minute of trying.
So don't give up. Before your next appt, make a list of all the drugs you've ever had, decide if you gave each one a fair trial (usually 4-6 weeks at an effective dose if you could tolerate that much and by itself), write down what specific effects each one had. Sometimes it turns out to be a little of this and a little of that just in a combination you haven't tried yet.
And as you mentioned therapy is critical, and exercise (in moderation if you're prone to overdo) is crucial.
It will work. I wouldn't have said that so confidently a few months back, but I'm a changed person (optimism for a start). Look at how treatment resistant I apparently was. I felt like I had gone in a circle for years.
Kate
Posted by ChrisK on April 20, 2002, at 5:44:23
In reply to Most treatment resistant person, ever..., posted by tb on April 19, 2002, at 15:03:55
Here's a page just for the Treatment Resistant. It may cover a lot you've been through but it might give you a couple of new ideas. My success after 20 years of off and on treatment came with the help of Zyprexa and Mirapex. Those added on to an AD that works a little bit got me over the hump. I wouldn't say I'm 'normal' but I'm functional and can enjoy things again.
Posted by Elizabeth on April 20, 2002, at 13:12:30
In reply to Most treatment resistant person, ever..., posted by tb on April 19, 2002, at 15:03:55
> I am really discouraged. I must be THE most treatment resistant person EVER.
Lots of people feel this way when they've tried a bunch of things and nothing seems to be helping. It's the depression talking! Don't give in to the despair & demoralization. I tried a lot more medications than you have before I found something that worked -- but I *did* find something (a combination of somethings).
Some things that are not on your list -- ask your pdoc if any of these might have a chance:
* You've tried two of the SSRIs, so that's _probably_ not the way to go, yet there's still a small possibility that one of the others (Paxil, Luvox, Celexa) may work for you.
* You've only tried one of the tricyclics (clomipramine). Imipramine and desipramine have been found effective in treating bulimia nervosa. Of the two, desipramine usually has milder side effects.
* MAO inhibitors are always something to consider if the usual stuff doesn't work; also, they've been studied specifically for bulimia. Don't get scared off by food interactions -- they've been overhyped, and there are really only a few foods that actually interact with them. Reversible MAOIs (moclobemide, brofaromine, toloxatone) might be worth trying if you can get it, but if they don't work or are too hard to get, the older (irreversible) MAOIs are still worth trying, since they work for a lot of people who don't get any benefit from the reversible ones. The MAO-B inhibitor selegiline (which becomes nonselective at higher doses) may also help.
* Trazodone is an antidepressant that has been established as effective for bulimia and is dissimilar to the other antidepressants. It tends to be sedating for most people, but my experience has been that the sedation goes away after a little while.
* Benzodiazepines: you didn't mention any of these, yet they help people with a wide range of psych problems. There may be some specific reason why your pdoc has chosen not to prescribe them, though; that's something you need to talk about. If you do decide to try one, Klonopin would be my first choice.
* Atypical antipsychotic drugs, taken in low doses, can sometimes help people with nonpsychotic depression and some related problems. They might be worth trying, particularly in combination with an antidepressant, if you find one that works partially.
* There are several anticonvulsants other than Topamax that can help with mood disorders and might be of use to you: Lamictal, Trileptal, Tegretol, Depakote, Neurontin, Gabitril. (I may be missing some, but those are the ones I can think of.)
* Lithium helps a lot of people with mood disorders, although it might not be so great for the bulimia.
* What dose of Buspar did you try taking? Buspar can work better at high doses, up to 90 mg/day (or even more). (It's perfectly safe: it was originally tested as an antipsychotic in doses in the thousands!)I might be able to say something more specific if I knew more about what's going on for you. For example: Do you have any diagnosis besides bulimia nervosa, and if so, which one is primary? (e.g., is the bulimia caused by depression? depression caused by bulimia? both independent, no cause-effect relationship?) What kinds of symptoms do you have? What's your body mass index? Did all the drugs you tried do absolutely nothing for you, or did some of them help a bit? etc. I'm not pressuring you to talk about anything you'd rather not talk about, but these are things that could lead to more precise ideas.
What sorts of therapies do they use at the eating disorders clinic? There should be at least some cognitive-behavioral therapy; that's something that helps a lot of people with bulimia and other types of impulsive behavior problems.
Do you keep a diary and note when you have a binge episode, how long it lasts, whether you purge, etc.? That sort of thing can be useful if you're trying to tell if/how much a treatment is helping.
I like Kate's idea of making a list of all the things you've tried, deciding if you gave them all adequate trials, if any of them helped in some ways, etc. If something helps partially, it might be worth sticking with it and perhaps combining it with other things.
Something else to consider that might be helpful: treating bulimia nervosa is not simply a matter of stopping the binge eating. Don't think of it as something for which you have to take appetite suppressants. Although drugs that decrease your appetite may help with the bulimia, they won't continue suppressing your appetite in the long term.
BTW, in case you're interested, here's the list of drugs I've tried (at least, that I can remember):
Prozac, Zoloft, Paxil, Effexor, Serzone, Wellbutrin, Remeron, trazodone, Buspar, nortriptyline, desipramine, amoxapine, Nardil, Parnate, Marplan, selegiline, Klonopin, Valium, Xanax, Ativan, Librium, Tranxene, Ambien, Sonata, Depakote, lithium, Lamictal, Neurontin, Trileptal, Cylert, Ritalin, Dexedrine, Adderall, Provigil, Zyprexa, Risperdal, Seroquel, Mellaril, Moban, propranolol, pindolol, clonidine, buprenorphine, MS Contin, Ultram
and there are even more where those came from! :-)
Some worked partially, some worked but caused problems, a lot didn't work at all. Today I'm taking Effexor, buprenorphine, and Ambien, plus Xanax as-needed and Trileptal for seizures.
So like I said, don't despair! There's hope.
-elizabeth
Posted by BarbaraCat on April 22, 2002, at 12:56:20
In reply to Most treatment resistant person, ever..., posted by tb on April 19, 2002, at 15:03:55
Hi Treatment Resistant One,
And I thought I had that dubious honor! I've been on every last one of the SSRIs and their spin-offs as well as the older TCAs over the past 20 years. They'd work for a while then depression would eventually break through and any dosage increase resulted in anxiety, insomnia and grinding of teeth. What's finally worked is recently adding Lithium and Klonopin to my Remeron. The Lithium supercharges the Remeron yet leaves me feeling even-keeled. I suspect the lithium would work with any of the ADs to prevent poop-out, but I like Remeron because it works best with my depression/anxiety profile.I tried Topomax to hopefully replace the Lithium (weight gain), but it made me feel horrible. The weight gain is an issue, but the only magic bullet to deal with that is getting to a place where I can whup my body into some daily exercise. Moving that stuck energy has also proven to be absolutely the best antidepressant for me, but totally impossible when I'm feeling really bad. Good luck and don't give up. The mood stabilisers seem to be the missing ingredient in the AD mix for many of us here. It's just patiently wading through til you find the right one. - Barbara
> Hey everyone,
> I am really discouraged. I must be THE most treatment resistant person EVER. I have been suffering from bulimia for the last 12 years. I have been on EVERY AD out there - prozac, zoloft, wellbutrin, effexor, buspar, serzone, remeron, clomipromine, naltrexone. I've also tried topamax, adderall, ritalin, and dexedrine to help potentiate the drugs. NOTHING HELPS. I don't even get the bad side effects from drugs anymore.
> I tried Topamax last week, full dose, and it didn't even make me tired let alone help with the binge eating.
> Does anybody out there have any ideas of what route I should take. My pdoc is stumped...guess it's time to find a new one?
> Thanks
> Tb
Posted by d. miller on April 22, 2002, at 19:06:36
In reply to don't give up., posted by katekite on April 19, 2002, at 16:59:29
Thank you for this post. I have felt very alone on this suject. This post has given my hope.
D. Miller
Posted by judy1 on April 23, 2002, at 11:30:42
In reply to Most treatment resistant person, ever..., posted by tb on April 19, 2002, at 15:03:55
How old are you? Most bulimics stop in their 30's no matter what treatment, not that I'm knocking treatment. Cognitive therapy helped me enormously but I swear it was marriage, children and age that stopped it, I think they call it a stable environment. Best of luck and I've known many, many people with EDs that took years to recover but they DID. Take care, Judy
Posted by sjb on April 24, 2002, at 14:15:21
In reply to Re: Most treatment resistant person, ever... » tb, posted by ChrisK on April 20, 2002, at 5:44:23
I'd be real cautious recommending Zyprexa to tb. I have similar symptons to tb, and if she binge eats, she should know that a lot of people experience an appetite increase/weight gain/cravings for sweets on this drug. I tried it once, briefly, in a combo with Ativan due to my alcohol abuse. (I tend to switch extremes, when I'm running high mileage I have a problem with binge eating, when I stop running, I have a problem with alcohol).
Anyway, experience with Zprexa was awful, filled with lethargy and much binge eating on cookies and such, esp. upon waking in the morning. I will add, obviously, that some people have been helped tremendously by Zyprexa and we are all different, but tb should be aware of the common side effects of this drug and it may be counterindicated for some one with a problem of binge eating.
Posted by sjb on April 24, 2002, at 14:23:55
In reply to Most treatment resistant person, ever..., posted by tb on April 19, 2002, at 15:03:55
Lots of good advice here, stuff I needed to hear also. Just to add to what's already been said, I am of the mindset that not all SRRIs are the same. So far, Luvox has helped me a lot with many facets of my depression (alas, not much for the binge eating, I'm afraid) and last, but not least the side effects are much better. I do not have the insomnia and sexual shutdown that I experienced on Prozac and some of the other SRRIs. Don't get me wrong, the sex drive is still decreased from what it is on nothing, but not nearly to the extent that I experienced on other SRRIs and other ADs for that matter.
PS - Can you divulge where you are going for treatment. Understand if you do not want to do that and not sure if I'm wrong for even asking.
Posted by tb on April 24, 2002, at 16:37:05
In reply to Re: Most treatment resistant person, ever..., posted by sjb on April 24, 2002, at 14:23:55
sjb,
are you asking me, tb, where I am in treatment? I don't mind telling.
It's called The Clinic... it's located in Edmonds Washington.
Posted by Elizabeth on April 24, 2002, at 23:04:53
In reply to Re: Most treatment resistant person, ever..., posted by sjb on April 24, 2002, at 14:23:55
> Just to add to what's already been said, I am of the mindset that not all SRRIs are the same.
This is an important point. According to a recent study, when people who hadn't responded to one SSRI were switched to another SSRI, 50% responded to the second SSRI.
> PS - Can you divulge where you are going for treatment. Understand if you do not want to do that and not sure if I'm wrong for even asking.
Well, I don't think there's anything wrong with that. I think you have a right to ask any question, as long as you're polite about it. Of course, the person you're asking also has the right not to answer (again, as long as they're polite).
best,
-elizabeth
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