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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by aturtle16 on May 22, 2006, at 14:18:59
Hi everybody, I am new to psycho-babble. I believe I have treatment-resistant depression, as I have tried 4 different SSRI's + Wellbutrin (which made me worse)and see no difference...still having severe symptoms of depression. My pdoc is getting aggravated at me because I'm not responding (currently on 30 mg of Lexapro daily). He hasn't suggested shock therapy YET, but I don't want it anyway as I've heard horror stories about its side effects. I go to psychotherapy, too, but it doesn't seem to have an effect, either. Does anyone have any suggestions?
Posted by RetiredYoung on May 22, 2006, at 15:13:32
In reply to Treatment-Resistant Depression - Please Help, posted by aturtle16 on May 22, 2006, at 14:18:59
There are a lot of avenues for you still to explore, before doing ECT (i.e. "shock therapy"). For example, I take Prozac and augment it with Zyprexa, an atypical antipsychotic, and Lithium. The results are far from perfect, but are much better than how I responded to Prozac alone.
Other examples would be tricyclics (e.g. nortriptyline) or MAOIs (there is a new patch form out now called EMSAM).
Good luck!
Jim
Posted by notfred on May 22, 2006, at 15:36:20
In reply to Treatment-Resistant Depression - Please Help, posted by aturtle16 on May 22, 2006, at 14:18:59
I do not think failure of one class of antidepressants and a novel one like Wellburtin would indicate you are treatment resistant. There is still alot to try as others mentioned. none of the SSRI's work for me, nor did Welbrutin 2 decades ago, but it does now. Some TCA's and Effexor have worked well in the past.
!f
Posted by B2chica on May 22, 2006, at 15:46:18
In reply to Re: Treatment-Resistant Depression - Please Help » aturtle16, posted by RetiredYoung on May 22, 2006, at 15:13:32
retiredyoung mentioned lithium but what about other mood-stabilizers as well.
i think others had great ideas too. zyprexa helped me. and moai's are always an option.
i think you have many options left before you start worrying about tx resistant. please give it time.best wishes.
b2c.
Posted by yxibow on May 22, 2006, at 16:02:10
In reply to Treatment-Resistant Depression - Please Help, posted by aturtle16 on May 22, 2006, at 14:18:59
> Hi everybody, I am new to psycho-babble. I believe I have treatment-resistant depression, as I have tried 4 different SSRI's + Wellbutrin (which made me worse)and see no difference...still having severe symptoms of depression. My pdoc is getting aggravated at me because I'm not responding (currently on 30 mg of Lexapro daily). He hasn't suggested shock therapy YET, but I don't want it anyway as I've heard horror stories about its side effects. I go to psychotherapy, too, but it doesn't seem to have an effect, either. Does anyone have any suggestions?
That's not the end of the road by any stretch -- there are as mentioned still all the tricyclics (TCAs), tetracyclics (Remeron) which is actually a fairly powerful antidepressant, there are 5 true SSRIs (lexapro is a metabolite of Celexa), so there's one you probably havent tried (Luvox ?). There are even odd old antidepressants like Amoxapine (an old idea that is comparable to Symbyax) and Trazodone (and Serzone though you have to watch your liver). There's neuroleptic augmentation of SSRIs. There are the SSNRIs Effexor and Cymbalta (which has shown some good results in those who didnt respond to others).
I don't think he's getting aggravated at you -- if he is getting aggravated at you, there's something else going on between the two of you or he's not being the patient doctor that you need. But that is just my opinion.
And I'm sure I've forgotten a few more, not to mention MAOIs, which have their own pitfalls, but there's a whole soup of them above which I would try before that or ECT.- cheers
Jay
Posted by BrianBoru on May 22, 2006, at 17:06:55
In reply to Treatment-Resistant Depression - Please Help, posted by aturtle16 on May 22, 2006, at 14:18:59
Forget ECT entirely ! It will destroy your brain. I am resistant to the SSRI medications also. None of them work for me. Try one of the older tricyclics. I use Sinequan with good success. I just dumped (literally - in the toilet) the SSRI's a couple of week ago and went back to Sinequan. I feel much better - much calmer, and more productive and motivated. The pschotherapist I go to said he has seen much better results with the TCA's than with any of the newer drugs.
Posted by linkadge on May 22, 2006, at 17:20:28
In reply to Re: Treatment-Resistant Depression - Please Help, posted by BrianBoru on May 22, 2006, at 17:06:55
Newer does not necessarily equate to better.
Doctors just try to push the newer antidepressants because they are thought to be safer. A lot of studies show they can be less effective than the TCA's.
I too agree about ECT. It will fry your brain. I know that "fry" is not a technical term or anything.
Linkadge
Posted by BrianBoru on May 22, 2006, at 18:08:03
In reply to Re: Treatment-Resistant Depression - Please Help » BrianBoru, posted by linkadge on May 22, 2006, at 17:20:28
"Fry" may not be a technical term, but it does adequately describe to some extent what may happen to your brain. Condemned prisoners who have been electrocuted are found at autopsy to have "cooked" brains ! There is not a huge difference in the voltage applied.
Posted by blueberry on May 22, 2006, at 18:18:01
In reply to Treatment-Resistant Depression - Please Help, posted by aturtle16 on May 22, 2006, at 14:18:59
Often times when antidepressants aren't working, a medication from a different class will.
There are several mood stabilizers where lithium or lamictal both have built in antidepressant. Often with topomax and sometimes with depakote.
There are antipsychotics like zyprexa or seroquel, where either one added to one of your previous ADs might have worked great. There are stimulants like ritalin or adderall, for ADHD and treatment resistant depression. Some theories out there say depression can have a GABA origin, in which case xanax or klonopin could work. If you want to stay in the antidepressant class, go with one that works on serotonin and norepinephrine both, like cymbalta or nortriptyline. Or if you can handle harsh side effects, go with one of the other powerhorse tricyclics.
In any case, whatever you do, if you get even a hint of improvement on whatever you try, but it isn't enough, don't give up on it. Instead, think of adding something else to it from a different class of meds.
Sometimes we keep trying to play baseball and losing the game, without realizing we are on a football field, if that makes any sense.
Posted by BrianBoru on May 22, 2006, at 19:00:45
In reply to Re: Treatment-Resistant Depression - Please Help, posted by blueberry on May 22, 2006, at 18:18:01
As for tricyclic side effects, in most cases they tend to disappear during therapy, usually in a few weeks. In my experience, the side effects of SSRIs do not disappear.
Posted by Phillipa on May 22, 2006, at 22:08:49
In reply to Re: Treatment-Resistant Depression - Please Help, posted by BrianBoru on May 22, 2006, at 19:00:45
Really? I don't tolerate the SSRI's except luvox but no positive benefits either. The benzos work best for me. Love Phillipa
Posted by pseudoname on May 23, 2006, at 13:52:28
In reply to Treatment-Resistant Depression - Please Help, posted by aturtle16 on May 22, 2006, at 14:18:59
Hi, aturtle.
I agree with the med suggestions above; I think Blueberry's summary is great.
Plus, there's some safe & easy somatic options like light-box therapy and fish-oil supplements.
After most of those options (and ECT) failed for me, I finally found relief in the mild synthetic opioid buprenorphine (Subutex). That would probably be a ways down the list as yet for you, but I want you to know there are plenty of options still available.
> My pdoc is getting aggravated at me because I'm not responding
Wow, it's not *your* fault at all! Do you feel comfortable enough with him to ask about that? Whether he's really aggravated (and with YOU)? If you don't, could your therapist talk to him about it? I hope you at least bring up that concern with your therapist. It may be that your pdoc really cares about you and is frustrated in his own self-evaluation about helping you.
Pdocs can be clueless about how they're coming across.
On the other hand, if appointments with him are truly bad experiences and he continues with such a narrow range of treatments, it may be worth considering that you have other options there, too.
Good luck. Please keep posting how it goes.
Posted by nellie7 on May 23, 2006, at 14:06:39
In reply to Treatment-Resistant Depression - Please Help, posted by aturtle16 on May 22, 2006, at 14:18:59
Hi,
Are you sure you suffer from primary depression and not depression as a symptom of another condition?
Just a thought...I hope you find something that will make you feel better.
Take care,
Nellie.
Posted by Paulbwell on May 24, 2006, at 4:45:25
In reply to Re: Treatment-Resistant Depression - Please Help, posted by blueberry on May 22, 2006, at 18:18:01
Blueberry:
"There are stimulants like ritalin or adderall, for ADHD and treatment resistant depression."
--Sometimes these work better than other treatments:-REMEMBER THAT AMPHETANINES WERE THE ORIGINAL ADs.
A 'DEXEDRINE' REPORT FOR DEPRESSION:
"Dexedrine Took Me Out of Hell!
DEXEDRINE TOOK ME OUT OF HELL! Have been on it for over a month , after forty years of severe depressions that were broken only for brief periods. It was so bad that it was akin to severe physical torture. No antidepressants helped much or for long. The low dose of Effexor I still am on just took the edge off. I have lived on only for my children's sake, knowing that eventually nature would take me out.Fortunately, I kept trying. Just over a month ago, I was diagnosed with ADD and tried Dexedrine 5mg for the first time. Within an hour my world calmed and everything felt so 'normal,' without the free-floating anxiety and depression I was used to! Focusing was suddenly easy - before it was nearly impossible.
Now I am on 15mg spansules twice a day and my depression has not returned at all! (My dry mouth is mostly gone, the only side effect.) I have energy and can always focus, combined with a natural sense of well-being - I have life and it is incredibly good! I am thankful to my good doctor - ADD is tough to diagnose in adults, especially with no hyperactivity as in my case.
I wonder how many poor souls are wandering this earth with untreated ADD and depression.... If you are one and read this, know that someone else understands and that help and life is possible!"
Lynx
A REPORT FOR THE MORE POWERFULL 'DESOXYN":-" Desoxyn for Major Depression
When I was diagnosed with depression, I was put on Effexor, which worked for a while, but whoseeffectiveness faded. Wellbutrin was added, and the same thing happened.
When I was diagnosed with MAJOR depression, my psychiatrist added Adderall. That was the most
effective medication, to date, but it too eventually faded, after about 4 months. Then I tried Desoxyn, partially based on the comments on Desoxyn for ADHD, on this website. It was far stronger than I had expected. I had been prescribed 10 mg, twice a day, but I started out taking 5 mg per day, in 4 spaced doses.
I have worked up to about 7.5 mg per day, still far less than what I was prescribed. The fact that I could take much more, and still be within prescribed limits, gives me some confidence. On Adderall, I was maxed out(40 mg/day) and still wasn't getting enough oomph.
It took me much longer to get acclimated to Desoxyn (2 weeks) than any other drug. At first, I felt like my eyes were stuck open, and I wanted my Adderall back. After 2 weeks, though, I felt quite normal. The only drawback I have noticed, so far, is that I have to take my last dose at about 130pm in order to avoid insomnia; so, in the late afternoon, and evening, it is not as easy to function as it is in the morning and early afternoon.
I have no risk or desire to use Desoxyn, recreationally. If I go over my aforementioned therapeutic dose, I get nervous and feel worse. Desoxyn is, by far, the best drug I have tried for major depression. It's too bad it's getting such bad press, these days!
Dosage: 5 mg. tablet
Frequency: 2 tablets 2 x day
Total Length: several months
Brand Desoxyn."Theres also numerous reports for Opiates/oids for depression.
CHEERS
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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