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Dr. Bob is Robert Hsiung, MD,
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Posted by willyee on October 30, 2005, at 16:08:04
In reply to Re: Treatment resistant depression, posted by gibber on October 30, 2005, at 15:51:10
> Interrupted,
> I wanted to add my two cents here. One poster mentioned liquid deprenyl which as far as I know is selegiline (an MAOI). MAOIs you don't want to mess around with and certainly cannot be combined with SSRIs. I have TRD and am marginally functional on prozac and strattera. I have an appointment this week and my doctor should be pulling me off those meds and trying nardil, parnate, or selegiline. the Selegiline patch should be out soon too which lessens the food restrictions.
>
> gibber
Im rather confused by your post,you seem to be aganist Maois at first in your post,which is fine,but then you say you are planning to go on them?
Posted by willyee on October 30, 2005, at 16:22:42
In reply to Re: Treatment resistant depression (To Willyee), posted by Girlnterrupted on October 30, 2005, at 14:18:58
> Thanks for your advice, Willyee. You seem to have a great deal of information and knowledge on this subject. I appreciate your input. I actually knew that either Nardil or Parnate would probably be the most likely ADs to target my type of depression.
>
> However, I have asked over 5 psychiatrists to prescribe them, and none of them would do it. They simply don't want to add an additional responsibility to their easy-money-making jobs. It was "too much of a risk" to prescribe an MAOI, especially when there's like 100 other new ineffective AD's that pose no risks, and they could simply keep me trying them and making money from it.
>
> But anyway, I'm very curious about the Liquid Deprenyl. Do you need a prescription in order to get it? Where can I buy it? Have you taken it? Is it as good as Nardil, or is it better/worse? (Never tried Nardil, but from what I've heard, it should work great for my type of depression.)
>
> Thanks in advance for any information on this matter.
Common problem just about everywhere,best thing is to find and OLDER docter chances are they actualy remember using the drug,where as younger docs who say no prob never prescribed the drug and have no idea of the reaction,in that case of course they will not want to risk their jobs on a drug theyere not comfortable with.My doc now still remebers when she used parnate a lot.I guess i got lucky there.As far as deprenyl goes,its an maoi,however it is most recomended at doses very low,between 1-10 mg.At this dose there is a subtle over all change in dopamine,not a rush like a stimulant and a chrash.
The low dose on deprenyl is said to keep deprenyl OUT of the maoi danger zone,and the low dose range 1-10 mg should not require any food or med restrictions,this is debated,but it is also what is stated most about the drug.
For now keeping it low like that would make it a good second option,with a primary med,as stated with the low dose you SHOULD be able to add it to any med with out hardm,most people use 1mg or 2mg a day.
The product is tiny so u wont be using it in high doses anyway or you would run out in a day.Yes its prescription here in pill form,but the liquid form is sublinsgual and believed to be entirly more effective,i have used the liquid dose,and at one point exper tremondous relief from it.
The liquid form right now is available over seas only,non prescription.Deprenyl itself when it is raised over this small dose amount is no longer selective on dopamine,and instead at doses of 60 mg etc behaves the same as the Maois parnate and nardil.It at this dose would also carry the same combination no nos of maois.
So if ur want a primary maoi,at this moment u would want to continue ur search for a doc willing to give either parnate or nardil,to use as ur primary med.
Liq deprenyl would b good if u had a med already but it seemed to lack something,adding it might show a good response in aweek or so.
Lastly i myself am hanging on to the hope of the introduction here of DEPRENYL via skin patch,not only will this provide medication through the day,avoiding those little red pills,but it is also believed to be at ur higher doses and still carry no restrictions.We wont know for sure till its company somerset gets it out for us.
This is something im watching very very close,it sadly its my main OPTION OF HOPE NOW,a non existent medication,pretty sad huh.
I have tons of info on resources,tips for docs to get them,deprenyl etc,more than ud ever want,if u need anything contacnt me via yahoo pm message brklyn234,if i dont respond leave an offline.U might want to i think i have info u absolutly need.good luck
Posted by blueberry on October 30, 2005, at 17:17:32
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
I realize you don't have schizophrenia or psychosis, but take a look at the atypical antipsychotics. Low dose zyprexa or seroquel in addition to your favorite antidepressant.
The reason is because in combination with ssri's, the APs significantly raise dopamine levels in the parts of your brain affecting depression, while at the same time decreasing dopamine in other parts of the brain affecting anxiety. They are also being used as mood stabilizers.
The good thing about the APs is that they don't require long trials like the ADs do...you'll know as soon as two days to two weeks if they're helping you or not. But if you want to tweek the dopamine system without developing tolerance any time soon, the APs in combination with ADs can do that.
There is tons of research to support this. I am sharing my own experience as well. Low dose zyprexa and low dose prozac gave me the best five years of my life before they began to poop out. That's a long time for any med to work so well. Like you, I believe I have dopamine hypofunction, and am again on the hunt...which will probably end up being another ssri and another AP and hopefully another five years of goodness.
Posted by SLS on October 30, 2005, at 19:13:13
In reply to Re: Treatment resistant depression » Girlnterrupted, posted by blueberry on October 30, 2005, at 17:17:32
Don't forget about combining MAOI + AP if an SRI doesn't do the trick. Nardil + Zyprexa *should* make for one hell of a combination. You could even add amantadine and chromium picolinate to help prevent weight gain.
- Scott
Posted by gibber on October 30, 2005, at 19:39:12
In reply to Re: Treatment resistant depression, posted by willyee on October 30, 2005, at 16:08:04
Sorry to be unclear. When I said don't "mess" around with MAOIs I meant don't go into it without understanding potential bad reactions with any meds or food you currently consume. For many of us I know these risks are far outweighed by the benefits of a med that works. I'm not familar with an augmentation strategy using an MAOI so I can't comment on that. If SSRIs and low dose deprenyl works thats great!
Posted by Phillipa on October 30, 2005, at 20:11:56
In reply to Re: Treatment resistant depression » willyee, posted by gibber on October 30, 2005, at 19:39:12
Seems like the drug of choice is an MAOI. Fondly, Phillipa
Posted by Emily Elizabeth on October 30, 2005, at 21:25:52
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
I don't know as much abt neurotransmitters as others do, but I also am in my late 20's and have TRD. I was wondering if you have tried any Tricyclic Antidepressants? Desipramine seemed to help me some. Also, I have some lithium in my combo now and that seems to have helped some. I say "some" b/c my depression is not totally under control, but some meds seem to have made a dent in it. TRD is not fun.
Best,
EE
Posted by willyee on October 30, 2005, at 21:41:05
In reply to Re: Treatment resistant depression » willyee, posted by gibber on October 30, 2005, at 19:39:12
Ive seen it commonly used,lots of times to fight off negative sexual side effects of ssris....from what i read i dident see any problems at the very low dosees.
But yes it must be so,ssri plus maoi is never ever something to be toyed with,i mean i toy personaly with stimulants,tcas,etc with maois,but never would i use ssri in combo.
Deprenyl at the low dose dosent behave as the others,thats why its the ONLY one used in that sceniro.Also ssris can sometimes lower dopamine,so its believed,so again the low dose deprenyl used lightly is believed to help there.I have used liquid deprenyl and i do agree at low doses it does accumalte and work.
At high doses it can make u feel like a madman.
Posted by Girlnterrupted on October 31, 2005, at 0:54:54
In reply to Re: Treatment resistant depression, posted by willyee on October 30, 2005, at 21:41:05
Which one is the best?
Why do I get the idea that nothing really works? Everybody here seem to have tried all kinds of MAOIs, and nobody sounds like they have their depression under control. Is this our fate? Lots of advice, but we're all still sunk in the darkness?
Please, if someone is being successful, let us know. Otherwise, it sounds as if we have all the answers, but nobody is getting cured anyway.
Posted by jerrympls on October 31, 2005, at 1:01:48
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
This seems to happen more and more - or more people are talking about it: where the very first AD they were on helped them tremendously and either a) they decide they're back on track and stop the med or b) the doc gets a "great idea" and screws with the meds. Then depression returns and the person's depression becomes treatment resistant - even to the very first med that helped so much.
This happened to me too. I was on Trazodone 75mg at night (14 years ago). Iin 2 weeks I was perfect - NORMAL! After 3 months on it my doc said I was "back on track" and could stop it. Well, I stopped it and here I am 14 years later searching for a cure - not responding to conventional treatments. Now it's like I have to have a med to help me be social and laugh, a med to help me focus and be motivated, a med to help me relax and not worry so much and a med to put me to sleep each night.
I digress - but what is this phenomena of responding very well to the first med and then not repsonding to any meds following the discontinuation of the first med? Does the brain's chemistry become intelligent to future invading mood boosters? Do you think perhaps the brain fights against later treatments somehow? Figures them out and blocks their effects via downregulation, etc?
curious..
Posted by Girlnterrupted on October 31, 2005, at 1:21:49
In reply to Re: Treatment resistant depression, posted by jerrympls on October 31, 2005, at 1:01:48
> I digress - but what is this phenomena of responding very well to the first med and then not repsonding to any meds following the discontinuation of the first med? Does the brain's chemistry become intelligent to future invading mood boosters? Do you think perhaps the brain fights against later treatments somehow? Figures them out and blocks their effects via downregulation, etc?I have no clue, and I wish so bad I could answer that question. I swear to god that if there is no cure for me, I'm going to say good-bye to the world and end it for once. This is equal to any other terminal illness, except that nobody recognizes it and we must take full blame for it! It's even worse.
Does Dr-Bob ever show up at these forums? Would he be able to help us with this?
Posted by willyee on October 31, 2005, at 1:24:11
In reply to Re: Treatment resistant depression, posted by jerrympls on October 31, 2005, at 1:01:48
I would not be surprised to believe one of two scenerios,A the brain quikly defends aganist these foreign toxins,kinda like fool me once shame on you,fool me twice shame on me.
Second a more scary thought,and one i dont simply blow off,i cringe to think this but maybe well come to find these DRUGS are in no way MEDICATION,they were simply DRUGS,POISON and yess maybe we expereianced minor relieaf but its common that it dont last,what if these drgs are doing SERIOUS damage to our brain circuitary,its possable all it would take would be the first drug,from then on we are now truly hanidcapped and searching for a drug to fix a problem we dont KNOW EXIST brain damge and the very drugs we keep trying are the ones frying it more?
Well regardless whats done is done i suppose.As i said as long as these billions of dollers continue to roll in for these drugs like alibilfy cymbalta zyprexa etc then everyones pocket stays fat and acnowledging any problems with these drugs will be the last concern of many.
A stuffed wallet goes a long way!
Posted by willyee on October 31, 2005, at 1:38:32
In reply to Re: So Nardil vs Liquid Deprenyl Citrate?, posted by Girlnterrupted on October 31, 2005, at 0:54:54
Youre,i agree.I dont understand why this page doesent make front headlines,make jaws drop,make someone for gods sake say WHOA WHOA WHOA,we have a problem here.We are prob some of the most intelligent people due to experiance youll find in regard to drugs available,both public and professional,im sure lots of us would piss of p-docs with our questions.
And yet with people like sls,chairman,ed others we at best are getting medacore results.I and this is my belief or disbelief only ,can not accept the fact that a large majority or even a fair amount of people are not here but instead in remission.ANyone who has been here,i truly believe will return in remission to help.We see people who are still here now.
As for the Maois,they continue to be the drugs that offer many at least a functionable life.They hold good track records.Dont get me wrong my first year on parnate was bliss.As far as what to take,my recomendation,and just that only,is
A Parnate if u are in a EXTREME state of depression,practicaly unmobile,one foot in the hospital,in need of help yesterday.Reason is although parnate is as robust with its social overall success,it is however POWERFUL and kicks in super fast!
If u r gonna respond,likly u will,then its very possable for a parnate user to initaly respond in 48 hrs.Parnate also its unlikly to have the common worse before better syndrome,parnate when it works will be like a light switch,and i believe can get a bed ridden person up and cleaning the house .
Nardil- If youre just discouraged,but have no problem with patieance,u migt wanna try this one.Nardil is more sound so it will take longer,more like a common AD to build up and work.Also its possable to feel a little worse first,as u feel the side effects etc of the drug before the benifit.
But if u wait,u can expect the possable outcome to be a very IMPRESSIVE social boost,people speak of it in the terms u spoke of ur first drug.You find urself talking to people,interacting.
Also nardil has more unpleaseant side effects,weight gain,sexual problems are very common,parnate mostly over hyperness and insomnia.
Deprenyl id only recomend as a add on to a previous treatment,or if its gonna be in a combo of a benzo or such.You dont want to make liquid deprenyl ur primary med right now,its just too darn expensive,but we all wait for this patch!
Posted by ed_uk on October 31, 2005, at 14:44:41
In reply to Re: Treatment resistant depression, posted by jerrympls on October 31, 2005, at 1:01:48
Hi J!
When was the last time you tried trazodone?
ed
Posted by Phillipa on October 31, 2005, at 17:45:42
In reply to Re: Treatment resistant depression » jerrympls, posted by ed_uk on October 31, 2005, at 14:44:41
All I know is what you are all saying is true. The first time I took paxil after three months. The lethargy, tiredness all went away and I was able to return to work. But the next time I was on it it did nothing. And I've tried all the SSRI's and SNRI's and even nortiptalline, remeron and they have absolutely no effect on me good or bad. You'd never even know I'd swallowed a med. Wonder if the placebo affect is what makes someone think a med will work again. Even my Daughter who took prozac for a short while. Went back on it when life was not good. And she said I was right it just didn't work. Fondly, Phillipa
Posted by Monkeyoga on October 31, 2005, at 19:43:28
In reply to Re: Treatment resistant depression, posted by willyee on October 31, 2005, at 1:24:11
> I would not be surprised to believe one of two scenerios,A the brain quikly defends aganist these foreign toxins,kinda like fool me once shame on you,fool me twice shame on me.
Unless you're President Bush, who won't get fooled again.
> Second a more scary thought,and one i dont simply blow off,i cringe to think this but maybe well come to find these DRUGS are in no way MEDICATION,they were simply DRUGS,POISON and yess maybe we expereianced minor relieaf but its common that it dont last,what if these drgs are doing SERIOUS damage to our brain circuitary,its possable all it would take would be the first drug,from then on we are now truly hanidcapped and searching for a drug to fix a problem we dont KNOW EXIST brain damge and the very drugs we keep trying are the ones frying it more?
I doubt it. Everything you eat has all kinds of compounds in it, probably even ones that act like meds, some that have never been subjected to clinical trials. Anything can be toxic if you take enough of it. At least the compounds we take have been investigated. As for long-term effects, I suppose there could be. So far I haven't heard of any. Has anyone else?
Posted by Girlnterrupted on October 31, 2005, at 21:49:31
In reply to Re: Treatment resistant depression, posted by Phillipa on October 31, 2005, at 17:45:42
I am just as puzzled as you are, and this phenomenon is destroying my life. This is something that psychiatrists should be able to answer, but they seem to have no clue. At least all the ones I've seen seem pretty much used to it and not caring too much anymore.
I honestly don't think it's placebo. The reason for this is that the first time I tried Celexa, it didn't work. The problem was the dosage, it was too low. I was ready to give it up thinking it didn't work (I started on 20mgs, 2-3 weeks) and my doctor urged me to try 40mgs before giving it up, but I almost refused because I was convinced that my problem had no cure. Hesitantly I went on 40mgs.
In two weeks, all of a sudden one day I woke up with this new, amazing feeling of inner well-being, balance, and unbelievable excitement to be alive. It felt as if all the negative events in my life had clogged my brain causing my depression, and the AD somehow unclogged it and I could see clear and FEEL well finally. The negative thoughts disappeared. I remember I even tried to think about negative things, and they wouldn't make me feel bad, they were GONE. I had all these amazing dreams, where I would take off and fly, and I would just propell myself so high, and people would look at me and would be amazed but nobody could fly but me. Like "nightmares" but in reverse.
If it had all been placebo, the med might have worked at 20mgs, and I wouldn't have felt the huge difference at 40mgs. Also, how could the good effects last a whole year, and suddenly end when I switched to the supposedly "better" and "improved" version of the medication? I was actually hoping that Lexapro would be even more powerful than Celexa and would make me feel even better. But surprisingly, it screwed me up really bad and it ended with the antidepressant effect of Celexa. Hell, not even going off Celexa alone would do that (sometimes I'd run out of Celexa before I saw my doctor, and was off Celexa for 10 days, and I was still happy as hell. I felt some withdrawal symptoms, but I did NOT feel depressed!!)
The switching to Lexapro was the killer. I have NO CLUE why. No doctor in the planet seems to be able to answer this question either. This is my sad truth, and the ONLY thing that keeps me alive is the hope that one day I will be back in that state. If I had never been in that state, I swear to god I think I probably would have killed myself a couple of years ago.
Posted by Chairman_MAO on November 1, 2005, at 9:08:06
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
My own personal no warranty algorithm for treating depression:
Drop all medications except necessary hypnotics, etc.
Get to 1mg/kg phenelzine. Give that a 4-8 week trial. If no result or inadequate response, try the following:
a) TCA/NE uptake inhibitor
b) DA agonist
c) psychostimulantsIf no rseponse after that, add opioid (buprenorphine is preferable, the easiest to get, one cannot OD on, is a kappa antagonist--many reasons why it is best for psychiatry)
If no result, add memantine, riluzole, or lamotrigine. Lithium can be considered here. If no result, add a dopamine agonist such as cabergoline 2.5mg/day.
For anxiety, alprazolam & adinazolam are the best benzos for depression, followed by clonazepam in some cases. Others can be too depressiogenic.
NOTE: at any time, tranylcypromine 0.7mg/kg (normal dose) or 120-200mg/day (high dose) can be considered (or isocarboxazid 50-80mg/day or selegiline 60-80mg/day) as the MAOI of choice.
Posted by CK1 on November 1, 2005, at 17:12:51
In reply to Re: Treatment resistant depression » Girlnterrupted, posted by Chairman_MAO on November 1, 2005, at 9:08:06
>This seems to happen more and more - or more people are talking about it: where the very first AD they were on helped them tremendously and either a) they decide they're back on track and stop the med or b) the doc gets a "great idea" and screws with the meds. Then depression returns and the person's depression becomes treatment resistant - even to the very first med that helped so much.>
This is ME. Paxil, my first AD, helped me tremendously for 3 solid years until it pooped out. Now, nothing works or meds that may work produce side effects strong enough that I can't get to a theraputic dose. This phenomenon is more common than anyone would like to believe! Doctors fail to recognize it!
Jerry, you nailed it right on the head.
Posted by Cecilia on November 2, 2005, at 3:11:33
In reply to Re: Treatment resistant depression, posted by CK1 on November 1, 2005, at 17:12:51
Hard to say which is worse-finding a treatment that works and then having it stop working or never finding anything that works at all. Anyone remember the book "Flowers for Algernon"? I`ve never found anything that helps my depression-sometimes I think it would be wonderful to at least have a short period of happiness before it was taken away and other times I think I`m better off not having to face that loss. Cecilia
Posted by SLS on November 2, 2005, at 7:20:34
In reply to Re: Treatment resistant depression, posted by Cecilia on November 2, 2005, at 3:11:33
> Anyone remember the book "Flowers for Algernon"?
I saw the movie.
The other one that kill me is "Awakenings".
Both stories are similar. My brief remissions from severe depression have felt like nothing less than awakenings of my consciousness and a recovery of my intellectual capacity. It is agonizing to watch them disappear, knowing that you may never have them again.
- Scott
Posted by Chairman_MAO on November 2, 2005, at 8:00:02
In reply to Re: Treatment resistant depression, posted by SLS on November 2, 2005, at 7:20:34
Every time I see a reference to that book/movie I get a lump in my throat because, as SLS said, to finally get to experience one's consciousness fully and feel alive instead of feeling like an unwanted visitor in your own skin, apart from and inferior to every other being, destined never to even have the capacity to know what it feels like to feel fulfilled, part of something, living up to one's potential, goal-directed, etc., only to have it wane again hours to weeks later.
This happened to me over and over with d-amphetamine as it has to so many dysthymics who for some reason just don't feel reward.
Posted by jerrympls on November 2, 2005, at 8:26:05
In reply to Re: Treatment resistant depression » jerrympls, posted by ed_uk on October 31, 2005, at 14:44:41
> Hi J!
>
> When was the last time you tried trazodone?
>
> edPorbably 5 years ago.
Posted by jerrympls on November 2, 2005, at 8:27:45
In reply to Re: Treatment resistant depression, posted by SLS on November 2, 2005, at 7:20:34
> > Anyone remember the book "Flowers for Algernon"?
>
> I saw the movie.
>
> The other one that kill me is "Awakenings".
>
> Both stories are similar. My brief remissions from severe depression have felt like nothing less than awakenings of my consciousness and a recovery of my intellectual capacity. It is agonizing to watch them disappear, knowing that you may never have them again.
>
>
> - Scott
>Scott that's right on! I feel the same way.
Posted by denise1966 on November 2, 2005, at 9:32:43
In reply to Re: Treatment resistant depression » Phillipa, posted by Girlnterrupted on October 31, 2005, at 21:49:31
Hi,
I know exactly what you mean. I foolishly came off Seroxat (which worked wonderfully just as you describe Celexa as working) 8 years ago thinking that I'd never get depressed again. Four years later the depression came back and nothing would work for two years apart from Zyprexa. Then a higher dose Seroxat started helping but never as well as it did before.
I asked my Psychiatrists why they don't work anymore and they haven't a clue. Istn't it a pity that they don't give scans by default when they prescribe antidepressants although I know it would be expensive.
I'd love to know what was happening in my brain when the Seroxat worked compared to what was happening when it didn't work.
I'd like to know what is happening in my brain after I take a Zyprexa as well.
Anyway I know exactly how you feel, if I hadn't got the memory of how these antidepressants can work when they do I wouldn't have anything to cling onto.
All the best
Denise
This is the end of the thread.
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