Shown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Craig Allen on July 20, 2003, at 16:41:17
i'm an atypical depression, possible bipolar II, as a lot of us appear to be on this board. i've gotten a very good and very brief response to different drugs over the last several months. my one constant is effexor xr 300mg daily. i get some help from it, not nearly enough. i was started on abilify a few months back - felt great for about a week, then nothing. i messed with the dose but i couldn't get any response. same story for seroquel. 4 great days, then nothing. increased and decreased the dose, still nothing. last week, i was started on lithium 600mg daily. again a much improved mood for 3 days, then nothing. i'm still on it, but based on this frustrating history of transient response, i'm not hopeful. anyone else have experiences like these?
Posted by SLS on July 20, 2003, at 20:34:40
In reply to need advice on transient response to meds, posted by Craig Allen on July 20, 2003, at 16:41:17
> i'm an atypical depression, possible bipolar II, as a lot of us appear to be on this board. i've gotten a very good and very brief response to different drugs over the last several months. my one constant is effexor xr 300mg daily. i get some help from it, not nearly enough. i was started on abilify a few months back - felt great for about a week, then nothing. i messed with the dose but i couldn't get any response. same story for seroquel. 4 great days, then nothing. increased and decreased the dose, still nothing. last week, i was started on lithium 600mg daily. again a much improved mood for 3 days, then nothing. i'm still on it, but based on this frustrating history of transient response, i'm not hopeful. anyone else have experiences like these?
Dear Craig,Your situation sounds very close to my own. Doctors have been banging their heads against the wall trying to get me well for over 20 years.
Briefly:
- Tricyclics: great response after 2 weeks that lasts for exactly 3 days.
- Tricyclic discontinuation: rebound improvement lasting 2 weeks
- Parnate: moderate response after 10 days that lasts for 3 days; sometimes precipitates severe mixed-state mania when combined with tricyclics
- Nardil: moderate to robust response after 10 days that lasts for a few days to several weeks.
- Nardil discontinuation: rebound severe mania
- Nomifensine (Merital): great response after 2 weeks lasting for exactly 3 days
- Effexor: initial good response that faded after a few weeks; thereafter a mild improvement at 300mg
* The best response I ever had was to a combination of Parnate 60mg + desipramine 150mg
I am currently taking:
- lamotrigine (Lamictal) 200mg
- imipramine (Tofranil) 300mg
- atomoxetine (Strattera) 80mg
- aripiprazole (Abilify) 10mgIt is still very early, but I have begun to respond to this combination upon the addition of atomoxetine 3 weeks ago. I remain hopeful, but am trying not to get too optimistic. It is difficult, though. I tend to be a constructive optimist. I guess it's a character flaw. :-)
I have tried over 50 drugs in various combinations since I was first diagnosed 21 years ago. At times, I have lost hope, only to have it come back and find me. I wish I could impart to you the hope that has kept me going for so long. I have always managed to find some treatment alternative that I had not yet tried, whether it be a new drug, an old drug being used in a new way, or permutations of drugs that I have already tried in different combinations. It is simple logic. Hope is probably there for you if you are willing to look for it. It should be. I doubt that you have tried as many treatment regimes as I have, including ECT. Of course, this is easy for me to say today, Sunday, July 20, 2003 at 9:21 PM because I am feeling better. If things continue as they are, I will be living proof that it is most likely that there is an answer for you as well. Sorry for the Pollyanna stuff. It's real, though.
Patrick McGrath, MD, at Columbia University put it so well to me several years ago: "For every new drug that comes to market, a certain percentage of previously treatment-resistant people will respond to it."
Believe.
Look for duloxetine (Cymbalta) before the end of the year.
Good luck.
- Scott
-------------------------------------------
Drugs that have demonstrated partial responses:- amitriptyline (Elavil)
- amphetamine (Dexedrine)
- aripiprazole (Abilify)
- bromocriptine (Parlodel)
- desipramine (Norpramin)
- imipramine (Tofranil)
- lamotrigine (Lamictal)
- nomifensine (Merital)
- nortriptyline (Pamelor)
- olanzapine (Zyprexa)
- paroxetine (Paxil)
- phenylzine (Nardil)
- risperidone (Risperdal)
- T4 (Synthroid)
- tranylcypromine (Parnate)
- venlafaxine Effexor
- viqualine
- ziprasidone (Geodon)Drugs that have made my depression substantially worse:
- bupropion (Wellbutrin)
- amoxapine (Ascendin)
- modafinil (Provigil)
- moclobemide (Manerix)
- protriptyline (Vivactil)
- lithium
- valproate (Depakote)
- T3 (Cytomel)
- reboxetine (Edronax)
- mirtazapine (Remeron)
Posted by SLS on July 21, 2003, at 10:49:42
In reply to Re: need advice on transient response to meds, posted by SLS on July 20, 2003, at 20:34:40
Hi again.
After rereading your post, I see that you indicated that you have tried multiple drugs over the last several months. You might not be giving these drugs an adequate period of time to be able to evaluate fully their effectiveness. While I was a research patient at the NIH, they regarded an early transient improvement as a "blip" that forecast a good response later. I was taught that one must give at least three weeks for a trial of any new drug or new drug dosage. It is a conservative approach that often yields success when treating a difficult case.
- Scott
Posted by Craig Allen on July 21, 2003, at 19:15:59
In reply to Re: need advice on transient response to meds, posted by SLS on July 21, 2003, at 10:49:42
hi scott. thanks for relating. i didn't know if anyone else had a history of these brief responses. as for staying on long enough to know if the response would return - i did. right now i'm staying with the lithium in hopes that it begins to help again. i forgot to mention in my post that i had an improvement on buspar also. that one was after i had been on it for a couple weeks and lasted about 10 days. the abilify, seroquel and lithium gave me an instant improvement. pretty strange, i don't know what to make of it.
Posted by SLS on July 21, 2003, at 19:35:29
In reply to Re: need advice on transient response to meds » SLS, posted by Craig Allen on July 21, 2003, at 19:15:59
> i forgot to mention in my post that i had an improvement on buspar also. that one was after i had been on it for a couple weeks and lasted about 10 days.
It is possible that the improvement was the result of the actions not of the buspirone itself, but rather, its main metabolite (1-PP). 1-PP acts much like Remeron, blocking NE alpha-2 receptors. Perhaps Remeron would make a good candidate for you.
> the abilify, seroquel and lithium gave me an instant improvement.
That is actually very typical.
If you come across a crystal ball, please let me know.
Today was disappointing for me. About midday, my mood dropped off rather abruptly. I have recovered somewhat, but do not enjoy the same degree of improvement that I had during these last few days. Still hopeful, though. Recovery from a long-standing or severe depression rarely follows a steady course, especially early in treatment. It is hard to guess if my feeling worse is just a temporary lapse or the signal of the end of the antidepressant response.
- Scott
Posted by Craig Allen on July 21, 2003, at 20:39:01
In reply to Re: need advice on transient response to meds, posted by SLS on July 21, 2003, at 19:35:29
what is your current med regimen scott? as for the remeron, it made me feel really out of it. it made me feel uncoordinated and uncontrollably drowsy. thanks for the suggestion though. the drug i haven't tried, which i would like to, is nardil. i read a lot of posts on this board raving about its effectiveness. once i stabilize on a lithium dose, i think i'll wean off the effexor, wash out, and give it a try.
Posted by SLS on July 22, 2003, at 9:23:54
In reply to Re: need advice on transient response to meds » SLS, posted by Craig Allen on July 21, 2003, at 20:39:01
> what is your current med regimen scott? as for the remeron, it made me feel really out of it. it made me feel uncoordinated and uncontrollably drowsy. thanks for the suggestion though. the drug i haven't tried, which i would like to, is nardil. i read a lot of posts on this board raving about its effectiveness. once i stabilize on a lithium dose, i think i'll wean off the effexor, wash out, and give it a try.
Hi Craig.Currently, I am taking:
lamotrigine (Lamictal) 200mg
imipramine (Tofranil) 300mg
atomoxetine (Strattera) 80mg
aripiprazole (Abilify) 10mg
NADH (Enada) 10mgI am very confused today as to what is going on. I felt better for about 4 days. Last night I crashed and felt pretty poorly first thing this morning. However, I discontinued NADH on Thursday to better elucidate which drugs were contributing to the improvement. Unfortunately, my apartment is to have some renovation work today, and I am doing everything I can to bring up my level of function. I would rather have given things a few more days to see if the NADH was really important. I took NADH 10mg when I awoke this morning. Perhaps it is an unrelated coincidence, but I am feeling better now. I don't know what to hope for.
Nardil is a good drug. The diet is not really all that restrictive. I have been on MAOIs on and off over the years, and had only one negative food reaction. I inadvertently bit off the end of a pepperoni pizza. Pepperoni is a definite no-no.
Good luck.
- Scott
Posted by TJO on July 23, 2003, at 9:36:11
In reply to Re: need advice on transient response to meds, posted by SLS on July 22, 2003, at 9:23:54
> >
>
>
> Hi Craig.
>
> Currently, I am taking:
>
> lamotrigine (Lamictal) 200mg
> imipramine (Tofranil) 300mg
> atomoxetine (Strattera) 80mg
> aripiprazole (Abilify) 10mg
> NADH (Enada) 10mg
>
> I am very confused today as to what is going on. I felt better for about 4 days. Last night I crashed and felt pretty poorly first thing this morning. However, I discontinued NADH on Thursday to better elucidate which drugs were contributing to the improvement. Unfortunately, my apartment is to have some renovation work today, and I am doing everything I can to bring up my level of function. I would rather have given things a few more days to see if the NADH was really important. I took NADH 10mg when I awoke this morning. Perhaps it is an unrelated coincidence, but I am feeling better now. I don't know what to hope for.
>
>
>
> Good luck.
>
>
> - ScottHi Scott :-)
I found some links that you might find useful-
http://www.jhasim.com/htmlfiles/articles/volume1/number3/interview.pdf
http://www.biopsychiatry.com/pramropbi.htm
http://www.smart-drugs.com/ias-depression.htm
http://www.psycom.net/depression.central.resistant-bipolar.html
Also a question-what exactly did T4 do for you and can you add it to your current meds?
Hope the links help.Tammy
>
>
Posted by pianolady on July 24, 2003, at 3:31:41
In reply to Re: need advice on transient response to meds, posted by SLS on July 22, 2003, at 9:23:54
Scott,
I hope I'm responding to the correct person. Either way I figure you're likely to read this post.
I read that you have worked at NIH and are dealing with atypical depression (Craig also?) and of the medications you have tried with differential success. I also noticed that you're currently taking Abilify. I am assuming from your post that you are fairly well educated on the meds you're taking.
What is your opinion about Abilify potentially being a new class of antipsychotics because of its action on the different dopamine receptors? I am interested from both the scientific perspective and from the perspective of someone who is actually taking the drug. Since you have obviously taken a variety of psych meds, I would assume that you have had a wide variety of reactions to them (as I have had). Do you find that Abilify seems to have a detectable difference in the way it "feels" or acts on you in comparison with its touted difference in psychopharmacological action?
I am interested because I am currently doing a study of the drug and because my pdoc is changing my antipsychotic medications around. Just over a week ago, he started me on Geodon. I am uncertain at this point whether this is going to be a good choice for me. He has also suggested Abilify as another option.
Posted by SLS on July 24, 2003, at 7:02:48
In reply to Re: need advice on transient response to meds » SLS, posted by pianolady on July 24, 2003, at 3:31:41
> I read that you have worked at NIH
I didn't work there. I was a research patient at the NIMH.
> and are dealing with atypical depression
The symptomology of my case resembles atypical unipolar depression, but because of drug-induced mania, I have been treated as being bipolar.
> What is your opinion about Abilify potentially being a new class of antipsychotics because of its action on the different dopamine receptors?
Some have placed on Abilify the moniker "DSS", an acronym meaning dopamine system stabilizer. Others prefer to simply call it a partial dopamine agonist. The first might be overstatement, the second is perhaps inaccurate. Abilify acts like a full and somewhat selective antagonist at dopamine presynaptic autoreceptors at low concentrations. Postsynaptically, it acts like a partial agonist, supposedly acting as an agonist when dopamine levels are low and like an antagonist when there is an overabundance of dopamine. Of the atypical neuroleptics that I have tried (Abilify, Geodon, Risperdal, Seroquel, Zyprexa), Abilify has provided me with the most potent antidepressant effect. In some respects, I guess Abilify might act as if one were combining low dosages of either amisulpride or sulpiride with either pramipexole or ropinerole. Geodon and Abilify share a property that the other atypicals do not. They are agonists of the 5-HT1a autoreceptor. This might contribute to their antidepressant properties. 5-HT1a agonism is thought to be responsible for the antidepressant actions of buspirone and gepirone.
- Scott
Posted by pianolady on July 24, 2003, at 11:00:25
In reply to Re: need advice on transient response to meds » pianolady, posted by SLS on July 24, 2003, at 7:02:48
Thanks for the info!
This is the end of the thread.
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