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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by zoey1122 on February 21, 2006, at 16:00:46
I have had depression since I was in Junior High School. It's been on and off for years, usually at least one major depressive episode per year, but last year my life was changed forever with a debilitating, incapacitating major depression. And it came with anxiety which I had never experienced so severely previously. The major depression at first only showed up in the mornings/afternoons and then I would be fine in the evenings. However, that quickly faded and soon I was in living hell every day, fighting to keep alive and to hang on to some hope that I would get better. To make a long story short, I came out of the major depression after 2 months and now experience depression on and off on a weekly basis, causing me to be on long-term disability from work. What I would like to know is if anyone has tried everything (I have literally tried almost every antidepressant and mood stabilizer) and found something that worked for them. In the past, the SSRI's would work well but would poop out after 6 months. I am now on Selegeline, Lithium, Lamictal and Seroquel which is not helping at all. My doc is saying we should look into VNS or ECT but I want to hold onto some hope that there is a cocktail that will work for me...
Thanks for any suggestions!
Posted by Racer on February 21, 2006, at 17:35:53
In reply to Major Depression - Treatment Resistant, posted by zoey1122 on February 21, 2006, at 16:00:46
If the SSRIs pooped out after 6 months for you, I wonder if that was a placebo effect rather than the drug working? That's my first thought.
But my second thought is have you managed to get to a therapeutic dose FOR YOU on any of them? That seems so obvious, but it's surprisingly common that that's the problem with the newer drugs.
Back in the days when I took nortriptyline, they had blood tests to check whether or not you'd gotten into the therapeutic window. I had to take a huge dose before I got there, but did respond once I had. The doctor was pretty shocked at how much I had to take in order to get there. With all the other drugs I've taken since then, I haven't been surprised to find that I needed very high doses, too. (Apparently I don't metabolise very well...) Anyway, while I haven't been surprised, the doctors have been. In fact, a number of doctors I've seen have wanted to change a drug because it wasn't working, only to find that it worked fine once the dose was high enough.
It's worth looking into the dose thing, as well as picking apart your depressive symptoms. If you know which symptoms give you the most trouble, and which symptoms have been improved on any given drug, that can help you tease out what might help for you.
Good luck.
Posted by blueberry on February 21, 2006, at 18:23:46
In reply to Major Depression - Treatment Resistant, posted by zoey1122 on February 21, 2006, at 16:00:46
I might suggest getting a full hormone workup, which you can actually do yourself through mailorder labs and not too expensive. Thyroid freeT3, freeT4, cortisol, dhea, testosterone, estradiol2, progesterone. If any of these are low normal, I think you are in a situation that justifies trials of treatment for those. Pdocs are trained to suppress symptoms, but rarely to find the causes. Hormones actually control brain function and moods and whenever I hear of someone with treatment resistance or frequent poopout, that is the first thing I think of. Mainly because that's the way my clinic sees things and several books too. Basically, if the hormones aren't right, no amount of meds in the world are going to work the way they should.
As far as ideas for meds, I can only say to look where you haven't already looked. Even if it doesn't make any sense. Actually, especially if it doesn't make any sense. Everything you've tried makes sense, and hasn't worked. Xanax? Other benzos? Stimulants? Prozac+zyprexa combination?
I would test those hormones as fast as possible. It might paint a picture that explains everything. I could be wrong. I'm just thinking out loud and trying hard to help.
Posted by vainamoinen on February 21, 2006, at 18:31:25
In reply to Major Depression - Treatment Resistant, posted by zoey1122 on February 21, 2006, at 16:00:46
From what I've heard, I have not taken them myself, the old-old school monoamine oxidase inhibitors like Parnate are without parallel. Although the dietary restrictions are quite limiting.
Also maybe a tricyclic antidepressant in combination with an SSRI, like imipramine and Prozac. I have taken that combo. The side effects can be daunting.
What about so called California rocket fuel, Effexor combined with Remeron? I've taken that combo and it is quite powerful.
Unfortunately as you can see I've been on quite a few combos and they all poop out after a while.
Right now I take Prozac and Seroquel and that works reasonably well.
Bright light therapy and fish oil? Don't laugh it helps.
Also, a book called "Feeling Good, the New Mood Therapy" by Dr David Burns. It's a self help book for depression based on cognitive therapy techniques. I have personally used the techniques in the book and highly recommend them. Specifically his two column technique of writing out automatic thoughts and then the rational response. You'd be suprized how much relief you can get just putting all that negativite thinking down on paper and then substituting more reasonable compassionate thoughts.
Good luck, you can do it!
Posted by TylerJ on February 21, 2006, at 20:09:18
In reply to Major Depression - Treatment Resistant, posted by zoey1122 on February 21, 2006, at 16:00:46
Zoey, I agree with Blueberry get all the tests done asap. I have had depression probs(severe) much like you, for over 20 yrs-it sucks i hate the disease!!! I've been on every ssri, every snri, many tca's, and the MAOI's. Parnate makes me feel like a million bucks...it's really an incredible drug for me, and many others. But, it doesn't work for everyone ( and don't be afraid of the diet-it's a piece of cake,no pun intended). The only problem with Parnate and absolutely all AD's is poop-out. However your doc can augment it with other drugs to help it work better and longer, i.e., Lithium, thyroid 3, nuerontin, pindolol,lamictal and many more. Parnate may be the way to go for you, or nardil for that matter. Anyway, it may be worth a try- you might be like me and have great results with an MAOI...many people who don't do well with ssri's, srni's, tca's, go on to do very well on MAOI's-and I have heard of people taking them for more than 20 years-no poop out! I've also had 24 ECT treatments, which I don't personally recommend(that's just my opinion, they work great for a lot of people, so please don't rule them out). Hey, I'm here for you, so if I can help you in anyway, don't hesitate to ask...I'll do my best to help you anyway i can. Take care and hang in there...I think this is the start of a good thing and hopefully you will be feeling much better soon!
Sincerely,
Tyler
Posted by Phillipa on February 21, 2006, at 20:30:57
In reply to Re: Major Depression - Treatment Resistant » zoey1122, posted by TylerJ on February 21, 2006, at 20:09:18
So you've aleady tried the SSRI's have you tried the SSNRI's? Fondly, Phillipa
Posted by zoey1122 on February 21, 2006, at 21:05:58
In reply to Re: Major Depression - Treatment Resistant, posted by Phillipa on February 21, 2006, at 20:30:57
Thanks for all the suggestions everyone! The interesting thing about the SSRIs is that they seem to work immediately and get me into a hypomanic state where I feel great but within 6 months it poops out. I am thinking I have Bipolar II which is why it's important for me to take a mood stabilizer. After thinking about all the meds I have taken when I see my Psychiatrist tomorrow I am going to ask to get back on Parnate. I was on it 2 yrs ago and it really got rid of my depression but I was unable to stay on it due to insomnia. Hopefully I'll be able to take the Seroquel with the Parnate as it helps me sleep. It's just disappointing the Selegeline didn't work for me as it is similar to Parnate. I did have blood tests which showed my thyroid level was a little low so I do take medicine for that. I just cannot wait to feel myself again and feel happy and confident in life. Depression is just so incredibly debilitating...
Thanks for all the support and quick responses!!
Posted by ed_uk on February 22, 2006, at 14:30:29
In reply to Re: Major Depression - Treatment Resistant » zoey1122, posted by Racer on February 21, 2006, at 17:35:53
Hi Racie
How much nortriptyline did you take?
Ed x
Posted by med_empowered on February 22, 2006, at 20:51:53
In reply to Re: Major Depression - Treatment Resistant » Racer, posted by ed_uk on February 22, 2006, at 14:30:29
hey. sorry about your troubles :-)
have you tried a stimulant and/or benzo? some docs don't like rx'ing these--they are controlled substances--but..they can help. A LOT.
Non-AD drugs sometimes help..Buspar, fish oils, 5-HTP, the conventional antipsychotics...lots of drugs could possibly help you out.
Posted by pseudoname on February 22, 2006, at 21:29:40
In reply to Major Depression - Treatment Resistant, posted by zoey1122 on February 21, 2006, at 16:00:46
> What I would like to know is if anyone has ... found something that worked for them.
I agree with the other suggestions. The med I finally found after 20 years of depression was the synthetic opioid buprenorphine (Subutex®). There are downsides and risks to it, and it's hard to get, but so far it's working for me.
Diary of my first couple months on it begins here: http://www.dr-bob.org/babble/20051112/msgs/579345.html
Good luck, zoey.
Posted by Racer on February 22, 2006, at 21:40:50
In reply to Re: Major Depression - Treatment Resistant » Racer, posted by ed_uk on February 22, 2006, at 14:30:29
> Hi Racie
>
> How much nortriptyline did you take?
>
> Ed xI can't remember anymore, that was twenty years ago. I think I remember taking 6 tablets per day, though. I'm thinking they were 50mg? Does that sound right? I know that the doctor was very, very surprised to have to go up so high. (And I remember that she would get this sort of worried/confused look on her face, every time I dragged in to her office, before it finally got high enough.)
'Though even then, frankly, it didn't do much until she told me to take L-tryptophan, too. I was taking, all together, 14 pills per day. The whole thing together did work, though...
Posted by ed_uk on February 23, 2006, at 13:25:58
In reply to Re: Major Depression - Treatment Resistant » ed_uk, posted by Racer on February 22, 2006, at 21:40:50
Hi Racer,
Perhaps you were taking 6 x 25mg, 150mg per day. Just a guess.
Ed x
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