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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by sdjeff on November 26, 2004, at 1:36:34
Hi,
My dx is Major Depression with Psychotic Features.
I've read in many places that Major depression is episodic, with periods of remission.
My experience with depression is a little different. My depression is a constant thing. It's been constant for at least a decade. Good moods for me are rare (occurrng 0-2 times a month) and last a couple of hours to a couple of days. Beyond that, I feel depressed, with varying intensity. My meds take the edge off, but no major relief. Physical causes have been pretty much ruled out.
Any thoughts?
Posted by denise1904 on November 26, 2004, at 7:09:04
In reply to Is it possible to be depressed ALL the time?, posted by sdjeff on November 26, 2004, at 1:36:34
Hi,
My depression has always been pretty constant regardless of external factors, I think chronic low grade depression is known as dysthimia.
The only thing that made me not depressed in the past and to some extent now(although they're not as helpful now) has been antidepressants.
I'm really sorry to hear that nothing you have tried as ever really helped but glad to hear ADs help a little.
You've just got to keep looking I guess and with all the research they're doing now, I'm pinning my hopes on a breakthrough.
Denise
Posted by banga on November 26, 2004, at 16:41:28
In reply to Re: Yes I think So., posted by denise1904 on November 26, 2004, at 7:09:04
In DSM IV language, there are various descriptive add-ons to describe a depression. For a bout to be considered an episode, it must be followed by a 2-month period remission. So you have to look at history--did you ever have depression followed by a 2-month remission, or once it started, it never ended (this scenario then is actually then a single episode that never ended).For instance, for you it might then be:
Major Depressive Disorder, Recurrent
-chronic
-without interepisode recoveryIt is a little unclear with the language--various ways to combine it to indicate an unremitting,long, horrid depression with no discrete episodes. But in any case the DSM does recognize a very long-standing disease.
It's a tough disease. I'm sorry to hear youve struggled so.
Posted by linkadge on November 26, 2004, at 20:39:20
In reply to Re: Yes I think So., posted by banga on November 26, 2004, at 16:41:28
I'm only 22 now, and I have been depressed as long as I can remember. I wrote songs about suicide in grade 8, and have been depressed most of this time.
I breif periods of improvement, but nothing can stop the fear that I am living in.
I went into remission for about 8 months one time when I first started AD medication, but meds doesn't work anymore.
Nobody believes me, but I've been on so many medications that I've damaged my brain. I remember my vision being so bright, but now everything is very dark.
Everybody says that no you're just depressed, your brain isn't dammaged. It is possable that
my brain is dammaged, and coming to grips with
that fact brings some consollation.Linkadge
Posted by denise1904 on November 27, 2004, at 14:31:19
In reply to Re: Yes I think So., posted by linkadge on November 26, 2004, at 20:39:20
Linkadge,
How can your brain be damaged when you seem able to absorb so much information and you even managed to make your own rTMS machine??
Denise
Posted by linkadge on November 27, 2004, at 15:01:39
In reply to Re: How can your brain be damaged??, posted by denise1904 on November 27, 2004, at 14:31:19
I blame my inability to experience pleasure, and my constant feelings of suicidiality on dammaged serotonin receptors. If I hadn't taking the ultra high doses of SSRI's prescribed to me (which caused unnatural feelings of well being for a while) then maybe I'd have a receptor or two left to let me experience a little joy from time to time. Throughout this time, I was experiencing symtpoms of serotonin syndrome which the docotors ignored. It has been shown that when symptoms of serotonin syndrome are present, then there is dammage taking place to the serotogenic axons and terminals.
In exctacy users, serotogenic dammage was still present unameliorated for years after the users stopped using. Ie my state is probably permanent.
Sure I can babble on, that doesn't mean I'm emotionally well myself.
I experience hate, pessimism, anxiety, panic attacks, fear, insomnia, inability to laugh, crying spells, catatonic states (sit staring at wall for hours), no appetite, shaking, trembling, nausia, chills, and the list goes on.
Basically I want to die all the time.
Linkadge
Posted by ed_uk on November 27, 2004, at 17:42:22
In reply to Re: How can your brain be damaged??, posted by linkadge on November 27, 2004, at 15:01:39
Linkadge, you are clearly very intelligent. If you can get your symptoms under control I think you have a bright future. Have you tried an MAOI?
Several years ago my anxiety was so severe I thought things would never improve. I was wrong. Things are much better now.
I wish you all the best..
Ed.
Posted by linkadge on November 27, 2004, at 21:28:52
In reply to Re: How can your brain be damaged?? » linkadge, posted by ed_uk on November 27, 2004, at 17:42:22
I tried parnate, and I had mixed results with that drug. On the one hand it made me feel much improved, but I think the dopaminergic effect was too much for me. Of all the AD's I've tried, this one tried to totally reorganize my thinking.
I think it was making me a little psychotic. I felt like a "cosmic contiousness". Kind of like I was stuck in a movie.
I felt so normal, that my mind convinced me that I had lied and faked depression to get on the med - (because I logically knew that it was possible for this med to induce euphoria)
These feelings were so strong, that I told the doctor I wasn't depressed and that I had lied to get on the med. He actually believed me (because he knew of my med knowledge) To make a long story short he took me off parnate, I went to the hospital.It's really messed up cause I felt so well that I'd convinced myself that I'd made up the whole depression story. Well I'm back to depression.
Parnate is very dopaminergic, it was like god was looking into my soul 24/7. Everthing I had ever done wrong, every person I had lied to came into my mind all at once. It was like the only way I could rid myself of it was to go around and tell the truth to everybody about what I had done wrong. It was scary as hell.
Even effexor made me slightly psychotic.
I have a history of psychotic depression "religious melancholy" and bipolar disorder in the family.
Depression is a very hard thing for me to treat.
Linkadge
Posted by ed_uk on November 28, 2004, at 6:38:43
In reply to Re: How can your brain be damaged??, posted by linkadge on November 27, 2004, at 21:28:52
Hello Linkadge,
Sounds like Parnate had a very dramatic effect on you. Have you considered trying Nardil + an antipsychotic +/- lithium?
Regards,
Ed.
Posted by linkadge on November 28, 2004, at 10:58:07
In reply to Re: MAOIs » linkadge, posted by ed_uk on November 28, 2004, at 6:38:43
I would like to try this combination, nardil + antipsychotic.
Linkadge
Posted by ed_uk on November 28, 2004, at 11:17:10
In reply to Re: MAOIs, posted by linkadge on November 28, 2004, at 10:58:07
Hi,
It sounds like a good combination for you! Which AP do you think you would try?
Ed.
Posted by linkadge on November 28, 2004, at 11:44:30
In reply to Re: MAOIs » linkadge, posted by ed_uk on November 28, 2004, at 11:17:10
We don't have the newer ones like geodon abilify here in canada, so probably zyprexa or seroquel.
Risperdal kinked my body up like a pretzil. I also found it the most depressing of zyp,risp,seroquel.
Linkadge
Posted by ed_uk on November 28, 2004, at 11:56:23
In reply to Re: MAOIs, posted by linkadge on November 28, 2004, at 11:44:30
Perhaps a low dose of olanzapine would be adequate to reduce the dopaminergic effects of Nardil. Would you consider continuing the lithium as well? Lamictal might also be worth a try.
Ed.
PS. Abilify has just been introduced but there's no sign of Geodon. Maybe it was rejected due to the risk of cardiotoxicity. The UK committee on safety of medicines probably doesn't want any embarassment after it licensed the AP sertindole (Serdolect) and quickly had to withdraw it due to QT prolongation.
Posted by SLS on November 28, 2004, at 12:17:13
In reply to Re: MAOIs, posted by linkadge on November 28, 2004, at 10:58:07
> I would like to try this combination, nardil + antipsychotic.
I would try Abilify first and Zyprexa second.
- Scott
Posted by linkadge on November 28, 2004, at 12:37:05
In reply to Re: MAOIs » linkadge, posted by SLS on November 28, 2004, at 12:17:13
Abilify isn't available in canada.
The only problem folks is that your record follows you nomatter what psychiartist you try to go here. They've labled me as "difficult" (like Elane on that Seinfeld episode). It's like a death sentence because they give you next to zero imput in your own treatment. Its like, "if you want a medication, *this* is going to be the one you take".
Linkadge
Posted by ed_uk on November 28, 2004, at 12:45:54
In reply to Re: MAOIs, posted by linkadge on November 28, 2004, at 12:37:05
I imagine they would let you try Lamictal. What do you think?
Ed.
Posted by lostforwards on November 28, 2004, at 15:46:51
In reply to Re: How can your brain be damaged??, posted by linkadge on November 27, 2004, at 21:28:52
Parnate sounds like it was working. You could've stayed on it and maybe gotten someone to talk to about all of the things you were starting to feel. You might've been able to get over them.
There is a difference between beating yourself up, being moralistic, and being psychotic. Who knows, maybe a part of you was just making it's way to the surface...or maybe not. I can't speak for you.
But after being totally numbed on APs, I had forgotten about a lot of my problems, when I tappered off, things started to flood back in a similar way.
I've also had the opposite experience coming out of hypomania, delusional thoughts that used to lurk in the background started to disappear and then I felt a bit empty.
If it was psychosis, an AP along with it probably wouldn't have hurt.
Posted by denise1904 on November 28, 2004, at 16:29:13
In reply to Re: How can your brain be damaged??, posted by lostforwards on November 28, 2004, at 15:46:51
Linkadge,
It sounds as though you are shouldering too much of the blame for the way you are feeling now. I think you should try and stop believing that the serotonin syndrome you say you experienced caused any damage to your brain and stop believing that you are entirely responsible.
If I looked back I could blame SSRIs for damaging my brain as I started taking them at 24 but I don't regret taking them for one minute, I have nice memories of my twenties now and I wouldn't even have that if I hadn't of taken them.
I know what you mean about not being able to experience pleasure, laugh etc, I felt exactly like that two years ago, I really felt as though I was geneticly programmed to kill myself, that it was somehow coded into me but I am now feeling better be it with the help of SSRIs.
And please stop thinking that you or the drugs are in some way to blame for how your feeling now. I have friends who overload themselves with drink and drugs and they still seem to come out of it unscathed without any brain problems. It's just luck of the draw.
Denise
Posted by linkadge on November 28, 2004, at 16:36:58
In reply to Re: How can your brain be damaged??, posted by denise1904 on November 28, 2004, at 16:29:13
I'm not so sure about that. I could take 80mg of celexa now and it would'nt make a dint.
Linkadge
Posted by denise1904 on November 28, 2004, at 16:44:31
In reply to Re: How can your brain be damaged??, posted by linkadge on November 28, 2004, at 16:36:58
Linkadge,
I know what you're saying but I have a friend who drinks to the gallon, plies herself with ecstacy, weed, Speed, Cocaine and the next day she seems as right as rain. Admitedly she's not particularly well balanced but neither does she ever seem really depressed when she's not taking anything.
I dare say she's not doing her brain any good but the fact that she has totally abused herself does not seem to have affected her ability to find pleasure or laugh and fun when not taking anything. Where's the logic in that?
So I'm saying you can't blame yourself or the drugs, afterall some people smoke weed and become psychotic and others don't its just the luck of the draw.
So if you had your time back, would you have never taken any antidepressants?Denise
Posted by ed_uk on November 28, 2004, at 16:55:54
In reply to Re: How can your brain be damaged??, posted by denise1904 on November 28, 2004, at 16:44:31
Link, despite the fact that you say your brain is damaged, your intelligence shines through. I think you will get better when you find the right treatment. Do you think your pdoc would consider Nardil?
Ed
Posted by linkadge on November 28, 2004, at 17:01:33
In reply to Re: How can your brain be damaged??, posted by denise1904 on November 28, 2004, at 16:44:31
If I could do it all over again from the beginning, I'd choose just lithium.
I suppose that your friend has an abundance of receptors to play around with. Some studies suggest that depressed/panic disorder patents have more than 50% fewer 5-ht1a receptors in the frontal cortex and hippocampus.Your friend may not know what she's got untill its gone.
Linkadge
Posted by denise1904 on November 28, 2004, at 17:04:46
In reply to Re: How can your brain be damaged??, posted by denise1904 on November 28, 2004, at 16:44:31
Linkadge,
When you do get better, please don't forget how bad you once felt and please put your intelligence all of this knowledge you've accumulated to some good use by going into a profession related to this condition and other mental disorders.
Hopefully then you'll be able to help other people like yourself.
But then maybe once you are better you might prefer to forget about depression, anxiety altogether.
Denise
Posted by denise1904 on November 28, 2004, at 17:09:05
In reply to Re: How can your brain be damaged??, posted by linkadge on November 28, 2004, at 17:01:33
Linkadge,
I thought the reverse was true, I thought that depressed people have two many 5HT1A receptors because of lack of serotonin or is it 5HT2A receptors that they have too much of?
Well anyway there must be a way of creating new 5HT1A receptors then if what you say is true.
Or maybe I'm oversimplifying things like I usually do.Denise
Posted by linkadge on November 29, 2004, at 10:46:58
In reply to Re: well there must be a way of creating new 5HT1A, posted by denise1904 on November 28, 2004, at 17:09:05
I think it's not the amount of the receptors but the sensitivity that is out of whack.
Ie depressed people have ultra sensitive 5-ht2a and 5-ht1a receptors. SSRI's don't decrease the number of the receptors but instead the affinity for the receptors.
Having too few receptors may be what causes the remaining ones to be ultra sensitive.
Linkadge
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