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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Cybele on August 2, 2005, at 17:48:05
I've posted on here quite a bit, but it's been a while. I have had dysthymia for over 30 years now (I am 44), and only rarely is it so bad I need meds. My "depression" is mostly manifested in difficulty concentrating. I used to be helped by Wellbutrin, which I have taken off and on for 10 years (more off than on), but over time it caused increasing REM sleep problems to the point where I could only take 100mg of SR in the morning. If I took any more than that my REM latency would drop to about 2 seconds. Now I know what narcolepsy must feel like.
The last 3 years have been very stressful for my family--job losses, a move, death of family member--and I've been really struggling. The last month has been really difficult, and I think I am going to have to drop out of the graduate class I was taking this quarter and will put a hold on my job search. I absolutely cannot concentrate. I watch TV, I play computer games, I minimally take care of house and family and finances.
A year ago I had some luck with Effexor. My depression was not as bad then as it is now, and I felt pretty normal when I was on teh Effexor. However, I gained 20 pounds, despite exercise and watchign what I ate, and I have yet to lose this weight. Any med that lowers my metabolism, as Effexor undoubtedly did, is not an option for me; it will make me feel worse!
I also cannot take SSRIs. I took 6 weeks of Paxil 10 years ago which made me feel much worse. I took 2 weeks of Prozac once and felt like a zombie.
My family doctor asked me to schedule an appt with a PDOC, but it takes 2 months to get in to see one with my health insurance. Until then, she would consider any AD I present to her based on my research. Exercise helps, but the effect is temporary--lately only lasting a couple hours.
So double depression, no SSRIs, no Wellbutrin, no Effexor, nothing infamous for weight gain... what's left?
Thanks for reading this and any thoughts you might have.
Posted by tecknohed on August 2, 2005, at 18:45:42
In reply to Double depression and hard time finding a med, posted by Cybele on August 2, 2005, at 17:48:05
> I've posted on here quite a bit, but it's been a while. I have had dysthymia for over 30 years now (I am 44), and only rarely is it so bad I need meds. My "depression" is mostly manifested in difficulty concentrating. I used to be helped by Wellbutrin, which I have taken off and on for 10 years (more off than on), but over time it caused increasing REM sleep problems to the point where I could only take 100mg of SR in the morning. If I took any more than that my REM latency would drop to about 2 seconds. Now I know what narcolepsy must feel like.
>
> The last 3 years have been very stressful for my family--job losses, a move, death of family member--and I've been really struggling. The last month has been really difficult, and I think I am going to have to drop out of the graduate class I was taking this quarter and will put a hold on my job search. I absolutely cannot concentrate. I watch TV, I play computer games, I minimally take care of house and family and finances.
>
> A year ago I had some luck with Effexor. My depression was not as bad then as it is now, and I felt pretty normal when I was on teh Effexor. However, I gained 20 pounds, despite exercise and watchign what I ate, and I have yet to lose this weight. Any med that lowers my metabolism, as Effexor undoubtedly did, is not an option for me; it will make me feel worse!
>
> I also cannot take SSRIs. I took 6 weeks of Paxil 10 years ago which made me feel much worse. I took 2 weeks of Prozac once and felt like a zombie.
>
> My family doctor asked me to schedule an appt with a PDOC, but it takes 2 months to get in to see one with my health insurance. Until then, she would consider any AD I present to her based on my research. Exercise helps, but the effect is temporary--lately only lasting a couple hours.
>
> So double depression, no SSRIs, no Wellbutrin, no Effexor, nothing infamous for weight gain... what's left?
>
> Thanks for reading this and any thoughts you might have.
>Hi. Sorry to here you've been haveing such a rough time lately. I'm no expert thats for sure, but I have one or two suggestions based on my own experience.
It seems to me, from the drugs you've already mentioned, both of which effect the Noradrenalin (norepinephrine) system, that a drug which targets this system might help. This neurotransmitter is greatly involved in concentration and focus. Even memory.
Personally I have found Lofepramine (a Noradrenergic Tricyclic) to be great for concentration and stamina/motivation, without any excessive stimulation (apart from at the very beginning, maybe). If you cann't get it in your country then Desipramine should be just as effective as it is Lofepramine's main and active metabolite.
Reboxetine, an SNRI (Selective Noradrenalin Reuptake inhibitor) may also be worth a look.
Also you may wish to look at drugs and supplements which increase the activity of acetylcholine, which is heavily involved in memory and concentration. DMAE (dimethylaminoethanol) and Pyroglutamate are 2 good examples and and can be combined for a synergistic effect. DMAE also elivates mood. These can take a while to work, but it's worth the wait.
I hope you find something that works well and soon.
Keep us updated on how you are.
Kind regards, Kev.
Posted by Racer on August 2, 2005, at 19:56:52
In reply to Double depression and hard time finding a med, posted by Cybele on August 2, 2005, at 17:48:05
If Effexor was helpful, you might try Cymbalta. It's a new serotonin/norepinephrine reuptake inhibitor, but it's more balanced than Effexor: it affects both 5HT and NE pretty equally at all doses, rather than Effexor which affects the Three Big Ones differently at different doses. (Effexor apparently hits hardest on 5HT at lower doses, with the NE coming on as the doses rise -- but don't ask me what the levels are.)
Desipramine was highly recommended to me, as being weight-neutral. (That's VERY important to me.) I couldn't take it, because it lowered my blood pressure too much, but if you're a bit more normal than I it shouldn't be a problem.
Good luck, and I"m sorry this is hitting you so hard.
Posted by Cybele on August 3, 2005, at 12:16:01
In reply to Double depression and hard time finding a med, posted by Cybele on August 2, 2005, at 17:48:05
Thank you *so* much for your replies! I now have something to research and talk to my doctor about.
Are you familiar with this article? I am definitely one of the "high reactors" to phenylethylamine:
http://bjsm.bmjjournals.com/cgi/content/full/35/5/342
2001 British Journal of Sports Medicine
Phenylethylamine, a possible link to the antidepressant effects of exercise?
A Szabo, E Billett and J Turner
Department of Life Sciences, Nottingham Trent UniversityI wish I could present myself to those researchers as a study case.
Off to the gym now to buy myself a few hours of post-exercise relief from this short-circuiting brain of mine. The Elliptical Trainer is my Friend.
Cheers,
Cybele
Posted by tecknohed on August 5, 2005, at 19:20:04
In reply to Tecknohed and Racer..., posted by Cybele on August 3, 2005, at 12:16:01
> Thank you *so* much for your replies! I now have something to research and talk to my doctor about.
>
> Are you familiar with this article? I am definitely one of the "high reactors" to phenylethylamine:
>
> http://bjsm.bmjjournals.com/cgi/content/full/35/5/342
>
> 2001 British Journal of Sports Medicine
>
> Phenylethylamine, a possible link to the antidepressant effects of exercise?
>
> A Szabo, E Billett and J Turner
> Department of Life Sciences, Nottingham Trent University
>
> I wish I could present myself to those researchers as a study case.
>
> Off to the gym now to buy myself a few hours of post-exercise relief from this short-circuiting brain of mine. The Elliptical Trainer is my Friend.
>
> Cheers,
> Cybele
>
Strange chemical that phenylethylamine. Chocolate is supposed to be rich in it. Yet I've read some reports suggesting it has little effect in man, at least when taken via an external route (eaten, injected, etc). There's an excellent book by Alexandra Shulgin called PIHKAL (Phenethylamines I Have Known And Loved) which covers the subject. I highly recommend a read!Also I thought that it was the Endorphins which were responsible for excercises mood-lifting effects.
Of course there's a lot of reports on PEA's activity also. Maybe its only active if manufactured from inside the body.
Maybe my brain just ticks overtime!?
Regards,
Kev.
Posted by Cybele on August 7, 2005, at 20:42:20
In reply to Re: Tecknohed and Racer..., posted by tecknohed on August 5, 2005, at 19:20:04
> Also I thought that it was the Endorphins which were responsible for excercises mood-lifting effects.
>
> Of course there's a lot of reports on PEA's activity also. Maybe its only active if manufactured from inside the body.
>
> Maybe my brain just ticks overtime!?Kev,
I think too much, as well :)
I've also always thought it was merely endorphins. When I was in my early 20s I met with a therapist who had written her dissertation on exercise helping depression. Her name is Judith Carl and I've never seen a copy of her diss., but would love to get my hands on it. She wrote it in the early 1980s, I believe.
From her research, she found that an individual needed to build up an "endorphin base" by exercising at least 5 days a week for 45-60 minutes. When you first start out your endorphin levels will peak after exercise, but then crash back down after 6-18 hours (or so). After exercising 5-6x/week for several weeks an endorphin base will be established and you would then be able to enjoy the antidepressant effects of the endorphins 24/7, without the peaks and crashes. The exercise needs to use the large muscles of the legs and at a sufficient level to break a sweat. It needs to be continuous, not stopping and starting.
My experience over the last 20 years has pretty much supported this. I found that three spinning classes a week pretty much covered it when I was feeling well, until real life stuff started becoming too stressful and it stopped doing the job. I went through a period of stressing out a lot (e.g., losing my temper with my kids, feeling like I wanted to punch walls or gouge my arms with my fingernails, overeating). After a while of this the major depression thing settled in and I worried about the things I wasn't getting done due to my lack of concentration. Then a new stage hit about a week ago where I just stopped caring about the things that weren't getting done. That's when I started this thread.
So, I've been on Desipramine since that day. I rang my doctor's office and she called it in right away. I am taking 12.5 mg 2x a day, and have had almost no side effects. I was a touch sleepy the first day.
Keeping my fingers crossed. I exercised 4 days this last week. If only I could get it to 6, but some days I just can't stand going to the gym and being around all the people there.
In the latest Harry Potter book, J.K. Rowling penned the word "wrackspurt" for things that float around a room and can enter your head and make it feel all fuzzy for a moment. I feel like I've hard a wrackscrum (wrackscrimmage?) in my head lately!
Cheers,
Cybele
Posted by Cybele on August 22, 2005, at 13:34:54
In reply to Re: Tecknohed and Racer..., posted by tecknohed on August 5, 2005, at 19:20:04
> > Thank you *so* much for your replies! I now have something to research and talk to my doctor about.
> >I finally got into see a Psychiatrist. Our visit (talking) lasted almost 1-1/2 hours! He told me that the baby dose of Desipramine that my family doctor had put me on never would have made any difference, plus he thinks it wasn't right for me. He believes, and I agree with him, that Lamictal is a better choice. He also gave me a script for Klonopin, which I have yet to fill.
It's been 4 days and I am taking a tiny dose of Lamictal daily, working up to full dose in 5 weeks.
Apparently I am one of those unlucky bipolar II folks who rarely, if ever, have hypomanias to enjoy. I have experienced it only once for sure, and that was 10 years ago and related to an antidepressant I tried.
This is the end of the thread.
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