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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 mmcasey on April 1, 2003, at 15:13:02
I just registered for this board although I have read a lot of it in the past when looking for certain info. Anyways... I've determined that I am treatment resistant (stage 2 to be exact, bc I've never tried a TCA). I've been in treatment (both medication and therapy and group and dbt) on and off for about 6 years. I have tried: wellbutrin -twice, celexa, effexor, and now i'm on paxil, plus I tried St. John's wort, also trazodone for sleeping. I've gone up to maximum doses on all of these and have had absolutely no improvement, not even minimal relief of some symptoms. I don't want to try an antipsychotic yet (mainly bc of weight gain), but I'm thinking of suggesting to my psychiatrist next time I see her (although I'm worried she won't be coorperative): T3 (thyroid hormone), modafinil (provigil), maybe remeron. My thyroid test came back normal, but I've heard T3 can be helpful anyway. Has anyone tried any of these? Had any success, or not? Thanks!
Posted by Pfinstegg on April 1, 2003, at 17:25:19
In reply to treatment resistant depression, posted by mmcasey on April 1, 2003, at 15:13:02
Yes, there is a place for using Cytomel in treatment-resistant depression even if your TSH falls within the normal range. The normal range for TSH is about 0.5-4.5; however, when treating depression, the ideal value for TSH is 0.5-1.0. This can be achieved by giving a combination of synthroid (T4) and Cytomel(T3). Sometimes, if your TSH falls in mid-range, just Cytomel will be sufficient. You need to take it twice a day, as it is metabolized quite rapidly. An endocrinologist will be familiar with this use for Cytomel, and will be able to get you to optimal levels quickly. It can make a real difference as an adjunct in treatment.
Pfinstegg
Posted by fallsfall on April 2, 2003, at 7:22:32
In reply to treatment resistant depression, posted by mmcasey on April 1, 2003, at 15:13:02
Hi
I take Provigil and it really helps. I have had extremely low energy with my depression for 14 months. If I take both Provigil and Strattera I see a big difference. Taking only one or the other doesn't do it - I need both. They give me clarity, motivation, significantly reduce the desire to hurt myself, reduce my need for sleep. The downside is that singularly and together they make me nauseous. Eating before I take them and occassionally taking Ginger keeps that under control.
Good luck!
Posted by mmcasey on April 2, 2003, at 9:44:38
In reply to Re: treatment resistant depression, posted by fallsfall on April 2, 2003, at 7:22:32
Thanks for the info. I've never heard of Strattera before -
I'm wondering if you take it for depression or for ADHD? Just curious
There does not seem to be a lot of information on it's use
in depression, although it would make sense, it being an SNRI.
Thanks.
Posted by fallsfall on April 2, 2003, at 21:37:44
In reply to Re: treatment resistant depression » fallsfall, posted by mmcasey on April 2, 2003, at 9:44:38
I take Strattera for depression. I looked for over a year for the current combination. It isn't marketed for depression (yet), but it works for me.
Posted by cubbybear on April 5, 2003, at 23:46:46
In reply to treatment resistant depression, posted by mmcasey on April 1, 2003, at 15:13:02
You didn't mention trying MAOIs such as Parnate or Nardil in your original post. These require diet restrictions and are prescribed only about 1% of the time because doctors and patients are afraid of them, but you should definitely look into MAOIs. I consider Parnate a life-saver.
Posted by mmcasey on April 6, 2003, at 11:51:15
In reply to Re: treatment resistant depression, posted by cubbybear on April 5, 2003, at 23:46:46
Yeah, I guess I should consider MAOIs, but it's true, I am afraid of them and don't want to deal with the diet restrictions. There is one called moclobemide which is a reversible MAOI and does not have those restrictions, but of course, it is not approved here in the US, only in Europe, maybe Canada. I would like to try that. What other kinds of side effects do you have? How difficult is it to stick with the imposed diet?
Posted by cubbybear on April 7, 2003, at 1:58:16
In reply to Re: treatment resistant depression » cubbybear, posted by mmcasey on April 6, 2003, at 11:51:15
You've come to the right personl! I am in the unique position of being an American who has had years of success with an MAOI (Parnate), but I'm currently living abroad, and I can't obtain Parnate here in Thailand so earlier this year. I tried Moclobemide (Aurorix). It did absolutely nothing for me and might have made my depression worse. There were no side effects, so I knew that something was wrong! I had to go back to the U.S. to get more Parnate last month.
As far diet restrictions go, one has to make some sacrifices. A lot has been posted on this board about them and you can do further research. The big no-no is almost any food thatt is aged or fermented such as cheese. Other prohibited foods are soy sauce and liver. There are also certain medications, particularly OTC remedies for coughs and colds, that you can't take with MAOIs. You really should do all the research yourself and make the decision but MAOIs have been considered the best choice for treatment-resistant depression. It's a crime that the big drug companies who make the SSRIs have wielded so much influence, and numerous doctors have been prejudiced against them. However, I think you should get yourself a doctor who is open-minded and willing to prescribe an MAOI for you.
Posted by cubbybear on April 7, 2003, at 2:08:55
In reply to Re: treatment resistant depression » cubbybear, posted by mmcasey on April 6, 2003, at 11:51:15
Sorry--in my previous post, I forgot to answer your question about side effects. I've found that, with Parnate, the side-effects have almost been the opposite of what others have posted. (Remember that everyone reacts to every drug in a different way.) My side effects have been increased appetite and craving for sweets and carbohydrates, leading to weight gain (which I desperately needed); low blood pressure sometimes, dry mouth, and--read this next one carefully--reduced need for sleep. That means no drowsiness, less fatigue and less desire to go to bed. (Great for night owls). If it's important for you to get plenty of sleep, you can supplement the Parnate with a benzo like Klonopin. I've also found that there's NO adverse effect on sexual functioning. Again--others might say otherwise, but these are my experiences. . .along with a lifting of ten million pounds off my brain and feeling like a human being again.
Posted by mmcasey on April 7, 2003, at 9:12:10
In reply to Re: treatment resistant depression, posted by cubbybear on April 7, 2003, at 2:08:55
That's great to hear about your experiences. I definitely
might ask about it when I see my psychiatrist. I feel like the
diet restrictions could be okay for me because I don't eat much
fermented/aged food anyway and I don't eat meat at all. What I
was concerned about was the chocolate and also yogurt (I eat a lot
of yogurt!). I am getting really desperate. I really need to
see a psychiatrist soon. Mine is hard to reach, and I am
thinking of switching to someone else who is more accessible,
because I just can't stand this! Thanks for your info, though...
it definitely has given me another option to think about.
This is the end of the thread.
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