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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Ethel Basset on May 5, 2003, at 10:43:55
Hello people;
I have been reading this message board for a couple of years and have received a lot of good information and encouragement from the posts.I never thought I would post anything but I am desperate. I have always been subject to depression, but I was at a point in my life where I could handle it because the circumstances in my life were good. I had finally reached the point where I had my dream job, a husband, a beautiful condo in southern California and all my bills were paid - and I wore a six 8!. I was able to stay mentally stable by trusting God.
Then my husband was transferred to the Midwest and this Californian went into a nose dive of depression due to culture shock upon moving to this state. We have been here three years and it hasn't gotten better. Right after I arrived here and realized I needed help, I sought a pdoc and was put on paxil. That helped the depression but I gained over 20 pounds and became puffy looking and tired and wear size 16 now. Needless to say, being overweight adds to the depression. I am now on Celexa and I am adding phentermine (on my own). I don't want to self-medicate but I am desperate to have more energy and to lose weight. I am thinking of adding Wellbutrin instead of phentermine.
Does anyone know of a good antidepressant, or combo of antidepressants that don't dull the senses, have energizing effects and that don't cause weight gain (might even promote weight loss?). I tried selegiline for one day, but didn't have the patience to wait for it to work. The depression came back with a vengence so I went back to Celexa. I hate having to take all kinds of medication, but I can't afford to have a nervous breakdown here in the middle of the flatlands. I have no family and no close friends that I can confide in. My husband is baffled by all of this. On top of it all, I am saying, where is God? Anybody have any ideas?
thanks.
Posted by fallsfall on May 5, 2003, at 14:52:41
In reply to Depressed and Desperate in the Midwest, posted by Ethel Basset on May 5, 2003, at 10:43:55
Please understand that this is based only on my limited experience.
You might look into Strattera. It is officially an ADHD med, but I take it for depression. Specifically, it did give me significantly more energy (actually, I have to take both Strattera and Provigil - either alone isn't nearly as good. I don't know if other people could get the result with one or the other). Strattera also does promote weight loss. I also take Prozac and Lithium (but they gave me the 12 months of no energy until we tried the Provigil and Strattera). My (limited) understanding is that you don't want to take Only Strattera for depression (it doesn't work on serotonin), but as an augmentation med it can be really good.
Good luck!
Posted by MattD on May 5, 2003, at 14:56:26
In reply to Depressed and Desperate in the Midwest, posted by Ethel Basset on May 5, 2003, at 10:43:55
I'm sure you will get lots of good advice on meds from others. I want to address another point--the Midwest vs. CA. I spent 29 years in the Midwest and then moved to LA. My mood increased dramatically. In fact, I've decided never to leave such a climate because of my mood. People from CA always wonder how I could handle the cold of Chicago, or the snow (or if they know anything about Chicago, the humidity during the summer). None of these were problematic for me. What *was* problematic was the 4-5 months of gloom during the fall/winter. One reason why spring was so euphoric in Chicago (and Madison) was that it was so dark and bleak and grey for so long. Even when it's sunny in Chicago during the winter, the sunshine is weak, at least compared to the sunshine in LA. I noticed this when I went back to Chicago for 3 weeks this summer.
Anyway, I hope you find relief. I wanted to confirm the difference between the two places, especially if you're from SoCal.
Best,
Matt
Hello people;
> I have been reading this message board for a couple of years and have received a lot of good information and encouragement from the posts.
>
> I never thought I would post anything but I am desperate. I have always been subject to depression, but I was at a point in my life where I could handle it because the circumstances in my life were good. I had finally reached the point where I had my dream job, a husband, a beautiful condo in southern California and all my bills were paid - and I wore a six 8!. I was able to stay mentally stable by trusting God.
>
> Then my husband was transferred to the Midwest and this Californian went into a nose dive of depression due to culture shock upon moving to this state. We have been here three years and it hasn't gotten better. Right after I arrived here and realized I needed help, I sought a pdoc and was put on paxil. That helped the depression but I gained over 20 pounds and became puffy looking and tired and wear size 16 now. Needless to say, being overweight adds to the depression. I am now on Celexa and I am adding phentermine (on my own). I don't want to self-medicate but I am desperate to have more energy and to lose weight. I am thinking of adding Wellbutrin instead of phentermine.
> Does anyone know of a good antidepressant, or combo of antidepressants that don't dull the senses, have energizing effects and that don't cause weight gain (might even promote weight loss?). I tried selegiline for one day, but didn't have the patience to wait for it to work. The depression came back with a vengence so I went back to Celexa. I hate having to take all kinds of medication, but I can't afford to have a nervous breakdown here in the middle of the flatlands. I have no family and no close friends that I can confide in. My husband is baffled by all of this. On top of it all, I am saying, where is God? Anybody have any ideas?
> thanks.
Posted by Snoozy on May 5, 2003, at 15:30:34
In reply to Depressed and Desperate in the Midwest, posted by Ethel Basset on May 5, 2003, at 10:43:55
Hi Ethel -
I've been on Wellbutrin for about 3 years. I haven't lost any weight, but I'm taking it to try and feel alert (helped for a while). I don't think you can lose a lot of weight just from taking Wellbutrin - but it's extremely rare for people to gain weight on it. A few pound loss is pretty typical I think. Prozac is another one that's not supposed to cause weight gain.
I have noticed that restaurants in the Midwest (high to low and everywhere in between) give you portions so big it takes 2 hands to carry the plate it's on. I haven't noticed this in CA. Even if you don't eat out a lot, I think it distorts your perspective on portion size.
The Midwest can be stultifying - weather-wise and social climate-wise. Some places (mostly college towns) are a bit more cosmopolitan, for lack of a better word. It would be great if you could meet some fellow expats (I don't know how you would do this - sorry). Some places it takes a lot of effort to feel comfortable in. If you have any hobbies or interests, you might want to consider joining groups about them, to meet some like-minded people. There are interesting people in the Midwest, I swear! It just takes some effort to find them sometimes.
How bad is the place you live - I mean is it a large city, or near anything?
Good luck and hang in there.
Posted by Ethel Basset on May 5, 2003, at 16:13:42
In reply to Re: Depressed and Desperate in the Midwest » Ethel Basset, posted by fallsfall on May 5, 2003, at 14:52:41
thanks everyone. Your encouragement helped alot!
Great suggestions. Gave me an uplift better than an antidepressant. Especially the confirmation about how different the environment is between California and here - although the people are very nice here. My husband, who was an Air Force Pilot, and traveled alot, can't understand why I am having such a bear of a time adjusting. I will keep trying to adjust...but I will probably still need the anti-depressants. I will give Celexa and Wellbutrin a try. Thanks!
Posted by leeran on May 5, 2003, at 17:56:55
In reply to Depressed and Desperate in the Midwest, posted by Ethel Basset on May 5, 2003, at 10:43:55
Oh my, your story sounds like a reversed version of mine (but the one thing I'm NOT depressed about is living in Southern California).
I moved here from the Midwest just about four years ago and had my dream job in the Midwest (I left it after many years, not due to the move, but it happened soon before, so I associate all of it together).
I had gained weight, too (fifty pounds over eight years, but somehow, I've been able to take off twenty five of it in the last two years - but it isn't easy).
Oh yeah, and like you, I have always been prone to depression and here lately, I worry that I'm going to alienate my husband - although he is completely supportive (thank God).
I'll tell you what I'm doing/taking. It’s not nirvana and that’s not what I’m looking for. Basically, I’m just try to keep the black cloud away and repair my self-esteem which was closely associated with my work.
Okay, here goes -
#1 - I am in very early menopause and have been for a couple of years, well, I guess it's technically known as perimenopause but it's more of a "pause" than a "meno." About a year ago I started on natural hormones prescribed by my gynecologist and prepared by a compounding pharmacy (they will ship anywhere – i.e. I have them shipped from Beverly Hills to where we live so I don’t have to negotiate twenty minutes of traffic).
I think the hormones have helped quite a bit with feeling less fragile (I would cry at the drop of a hat). I'm currently due for my check-up and may have to have the dosage adjusted due to testosterone/androgen issues, but overall, I’m convinced that it’s been a viable venture.
Note: Several years ago no one believed that I thought I might be in pre-menopause based on my mother's history (finished at 37). Eventually, the tests (and natural signs) indicated otherwise. That said, (depending on your age), the incredible fluctuation of hormones can be (IMO) a very real contributing factor to depression.
#2. About the same time (a year ago) that I went on the natural hormones I went on Wellbutrin. I didn't know it was my "wonder drug" until I misunderstood my psychiatrist and thought he wanted to replace the Wellbutrin with Lexapro (he meant to ADD it to the Wellbutrin) about six weeks ago.I now realize that Wellbutrin is my magic bullet (or a good portion of the magic bullet) considering how I crashed when I was off of it for a month and how I've improved since being back on it for the last two and a half weeks ago. I take 150 mg. SR in the morning, which brings me to step #3.
#3. My 15 year old son was diagnosed with A.D.D. in third grade (suspected in first grade). Although I could always identify with the problems he experienced it never occurred to me that I might have A.D.D. as well. We took him to a progressive behavioral science clinic in Beverly Hills for biofeedback therapy - and it helped immensely - but when he went off his Adderall we could see a marked decrease in his ability to function during his freshman year of high school. We started him back on Adderall and it was like turning a light bulb back on again.
About the same time, a friend of mine (whose son also has A.D.D.) admitted that she had wondered if SHE had A.D.D. and had tried one of her son's pills (it didn't do a thing for her). I must add that the doctor at the behavioral institute speculated as to whether or not I have A.D.D. based on the fact that I "self-medicated" (as he put it) on and off with phentermine during my adult years.
Hearing my son describe the difference he felt on Adderall (versus off) started me thinking about my own years in school. Although I did well in school, it was because I could always beat the system by taking classes in which I excelled (and avoiding left-brained subjects such as science and math like the plague).I found a psychiatrist in this area (I also took a very revealing online test for A.D.D.) and I am now taking 40 mg. per day of Adderall (more than my son does). Additionally, I have read articles about A.D.D. in women being exacerbated by menopause (great . . . one more thing to jump up and down about). The Adderall was added in January 2003.
#4 - I still felt a bit of the dark cloud that I have felt for years back in March so my psychiatrist prescribed Lexapro. I had an unexpected out-of-town trade show and ended up only took it for a week and a half the first go-round because it made me feel rather zombie-like (a condition that was due, in part, to going off Wellbutrin cold turkey). The psychiatrist strongly suggested I give it a second try in concert with the Wellbutrin, so I’m alternating between 2.5 and 5 mg. per night (for the last two weeks). The jury is still out on the Lexapro, but I'm willing to give it a shot for out a month or so, mainly because I've been fortunate enough to follow this board and have seen that it can take longer than two weeks to start to work effectively.
#5 - Now, this part isn't related to meds - but it has helped immensely. Due to early menopause (and probably several years of being on and off SSRIs) I started to put on weight all over, but particular in the “middle “ (a result of the body trying to cling on to whatever estrogen it has left, and abdominal fat cells are apparently quite "estrogen friendly").
I had liposuction last summer and as vain, expensive, and silly as it might sound - it helped my outlook immensely. It was a vicious cycle, hating my weight, not being able to lose the weight from my middle, becoming more depressed about my appearance, etc. I’m not advocating plastic surgery as a cure-all because I’m living proof that it isn’t, but given my “fix-it” personality, it has helped me feel less overwhelmed about the extreme weight gain.
#6. A few weeks ago it occurred to me that part of my ennui was due to not getting a good night's sleep. My husband (over a certain weight) becomes a mega-snorer and I was never getting into a deep sleep state. My psychiatrist (who makes me feel like there is SOME combination that will help as long as we keep tweaking) prescribed Ambien.
I can't begin to tell you what a difference it is to wake up and feel rested! Sleep deprivation (even if it's rather superficial, meaning you sleep, but you don't REALLY sleep) can be another vicious cycle. That’s another lovely by-product of menopause . . . insomnia.
Oh yeah, I take about a pound worth of vitamins/supplements per day as well and would probably feel a heck of a lot better if I started exercising again - which is #42 on my list of things to do.
I'm sorry this is so long, Ethel Basset, but when I read your post my heart went straight out to you. I’ve experienced the shock (of a good kind) moving from the Midwest to California and I’ve often wondered what it would be like doing it in reverse.
You didn’t mention it, but I’m going to make one overall suggestion – and that’s finding a psychiatrist you can really trust. I never dreamt that I would be taking four medications at one time and I most certainly wouldn’t feel comfortable with this kind of combination if it wasn’t done under the close supervision of a psychiatrist. I’ve been on Prozac and Wellbutrin (separately) prescribed by general practitioners but when it comes to getting to the root of the problem I have found a psychiatrist to be my best bet.
Good luck with everything. I am here to tell you that although I’m not exactly where I want to be in terms of self-esteem/mood, I am a HECK of a lot further along than I was two years ago/one year ago/six months ago, etc. It truly has been like that “What About Bob” movie (baby steps), but the entire point of my long-winded post is to tell you that it's been my experience that the MOUNTAIN CAN BE TRAVERSED!
Best wishes with everything,
Lee
p.s. I forgot to mention one other rather innocuous medication that I’ve taken for the last two years: Xenical. I’m not sure how much it has contributed to the twenty five pound weight loss since I’ve tried so many different avenues with the weight loss issue. Oh yeah, I work at home and I’ve gotten used to the side-effects (and they’ve subsided somewhat), but I wouldn’t necessarily recommend it to someone who travels all day for work, etc.
Posted by leeran on May 5, 2003, at 18:07:09
In reply to Re: Depressed and Desperate in the Midwest » Ethel Basset, posted by MattD on May 5, 2003, at 14:56:26
Matt,
I grew up in the suburbs of Chicago then spent several years in the "lower Midwest." It took a few years of living out here to finally realize that I didn't have to DREAD the fall because it brings winter!
My husband reminds me that this is why we pay so much for real estate, real estate taxes, car insurance, homeowner's insurance - but as a native of New York state, he feels even stronger about ever leaving than I do (he's been here 15 years, I've been here 4).
Some people will say "don't you miss the change of season?" and I don't at all! Besides, we have changes of season here as well - they're just more subtle.
As a former Midwesterner I felt compelled to agree heartily with your post. Living here has definitely with my depression to a certain extent.
Lee
Posted by MelD on May 5, 2003, at 18:13:02
In reply to Depressed and Desperate in the Midwest, posted by Ethel Basset on May 5, 2003, at 10:43:55
I came from Tennessee (God's Country to some of us) to NJ 30 years ago. The culture shock was stunning, and after this long i still think of Tn as "home". However, i eventually adjusted, as you will - as we all do when we have to. There are good and bad things about any place, right? (OK, no NJ jokes here, please.) Anyway - Leanns comments about hormones were right on IMO. Throughout my life (im 53) my depression has been affected by hormonal changes - most significantly pregnancy and menopause. As for what med has helped me, it has been Parnate, an MAOI. Weight loss is common with Parnate. God is there - turn to Him and he will guide you like He always has. Good luck, Melodie
Posted by leeran on May 5, 2003, at 18:28:00
In reply to Re: Depressed and Desperate in the Midwest, posted by MelD on May 5, 2003, at 18:13:02
"Throughout my life (im 53) my depression has been affected by hormonal changes - most significantly pregnancy and menopause."
Hey, Melodie -
Thanks for saying that about hormones. This is a constant source of curiosity/annoyance for me - i.e. I just wish I could see a bar graph of my depression to see what effect hormones have had on the big picture. I'm pretty sure that the fluctuation in hormones has had a profound effect, but it can be so gradual that it's hard to know for certain.
I think that if I could chalk it all (or a good portion of it) up to menopause I might feel less frustrated.
Thanks again! Your post really helped with my bout of PMS (Poor Me Syndrome). Just yesterday I bemoaned to my husband: "I just wish I knew how it had been - or is - for other menopausal women."
Lee
p.s. My psychiatrist did tell me (during my first visit) that many menopausal women come in feeling like they are slowly going insane! I need to ask him about that again (that day I didn't feel that way so I just filed it in my memory bank and forgot about it 'til right now).
Posted by MelD on May 5, 2003, at 18:42:45
In reply to Re: Depressed and Desperate in the Midwest, posted by leeran on May 5, 2003, at 18:28:00
Lee: The frustrating thing is not getting any help from the docs re the hormone/depression issue. I could hardly get them to even discuss it. I think its a terribly neglected area, research-wise and we are on our own for the most part. My depression worsened so badly at the onset of menopause that i was at my pdoc's in tears begging him to hospitalize me. My ob/gyn's response was HRT, which helped other symptoms, but did nothing for depression and may even have made it worse. Good luck to you in finding some relief, and hang in there. Mel
Posted by Carlos on May 5, 2003, at 20:35:35
In reply to Depressed and Desperate in the Midwest, posted by Ethel Basset on May 5, 2003, at 10:43:55
Sounds like you may be a canidate for a MAOI. I've learned from personal experience and posts here that pretty much all SSRIs cause weight gain, some more than others. There's a theory that if you gain weight on one SSRI you're likey to gain on all of them.
MelD is right about Parnate in that in a lot of causes it can promote weight loss/stability. I'm on Nardil, a different MAIO and I've have been losing the weight I gained on SSRIs and haven't felt better! Good luck and best wishes!
Posted by Ritch on May 5, 2003, at 21:39:30
In reply to Depressed and Desperate in the Midwest, posted by Ethel Basset on May 5, 2003, at 10:43:55
> Hello people;
> I have been reading this message board for a couple of years and have received a lot of good information and encouragement from the posts.
>
> I never thought I would post anything but I am desperate. I have always been subject to depression, but I was at a point in my life where I could handle it because the circumstances in my life were good. I had finally reached the point where I had my dream job, a husband, a beautiful condo in southern California and all my bills were paid - and I wore a six 8!. I was able to stay mentally stable by trusting God.
>
> Then my husband was transferred to the Midwest and this Californian went into a nose dive of depression due to culture shock upon moving to this state. We have been here three years and it hasn't gotten better. Right after I arrived here and realized I needed help, I sought a pdoc and was put on paxil. That helped the depression but I gained over 20 pounds and became puffy looking and tired and wear size 16 now. Needless to say, being overweight adds to the depression. I am now on Celexa and I am adding phentermine (on my own). I don't want to self-medicate but I am desperate to have more energy and to lose weight. I am thinking of adding Wellbutrin instead of phentermine.
> Does anyone know of a good antidepressant, or combo of antidepressants that don't dull the senses, have energizing effects and that don't cause weight gain (might even promote weight loss?). I tried selegiline for one day, but didn't have the patience to wait for it to work. The depression came back with a vengence so I went back to Celexa. I hate having to take all kinds of medication, but I can't afford to have a nervous breakdown here in the middle of the flatlands. I have no family and no close friends that I can confide in. My husband is baffled by all of this. On top of it all, I am saying, where is God? Anybody have any ideas?
> thanks.I would ask about a low-dose psychostimulant (especially dexedrine), combined with a low-dose serotonergic AD (such as Celexa).
Posted by nhg on May 5, 2003, at 23:14:55
In reply to Depressed and Desperate in the Midwest, posted by Ethel Basset on May 5, 2003, at 10:43:55
just for the record, living in so cal makes me want to kill myself. it is the lonliest city on earth. and sometimes i just wish it would rain.
Posted by MattD on May 6, 2003, at 15:27:19
In reply to Re: Depressed and Desperate in the Midwest » MattD, posted by leeran on May 5, 2003, at 18:07:09
I actually do miss the change of seasons, the snow, the crisp fall air. I miss the lakes, the open land. I think that the Midwest has a lot going for it. But those 4 months of grey (though it's been grey in LA for it seems like forever now) were intolerable.
Mattt
> Matt,
>
> I grew up in the suburbs of Chicago then spent several years in the "lower Midwest." It took a few years of living out here to finally realize that I didn't have to DREAD the fall because it brings winter!
>
> My husband reminds me that this is why we pay so much for real estate, real estate taxes, car insurance, homeowner's insurance - but as a native of New York state, he feels even stronger about ever leaving than I do (he's been here 15 years, I've been here 4).
>
> Some people will say "don't you miss the change of season?" and I don't at all! Besides, we have changes of season here as well - they're just more subtle.
>
> As a former Midwesterner I felt compelled to agree heartily with your post. Living here has definitely with my depression to a certain extent.
>
>
> Lee
Posted by Ellie's Mom on May 17, 2003, at 22:40:38
In reply to Depressed and Desperate in the Midwest, posted by Ethel Basset on May 5, 2003, at 10:43:55
I grew up in Northern Indiana and let me tell you that January-April just plain sucks. I suffer from depression anyway, but even most of the people I grew up with would put on weight and hide out until the weather started to change.
I could go down the list about the ADs I've tried, but the truth is that every body reacts in its own way. If you're willing to go through a trial and error period, it might be worth it. I've given up on ADs and am currently trying Lamictal, a mood stabilizer with AD effects.
But more importantly -- please consider finding a way to make an annual trip to a pleasant climate every year in late January. If you can afford it, consider spending a couple weeks to a couple months (maybe with old friends still in California?)
You'd be amazed. Not only is it a weather thing, but it's also depressing to be around seasonally depressed people and to try to find social contacts during that tough time. It's like people go into hiding! I grew up among the Amish, so at least they'd brave the weather for chores (but weren't too chatty if you know what I mean.)
Good luck, Ethel. August and September are magical in the fields of corn after tornado season is over. Learn to love it. Or get out.
This is the end of the thread.
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