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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by invisibleman15010 on August 5, 2006, at 13:20:02
Hi Group,
It has been a few months since I have posted. I hope everyone has had more luck with treatment and meds. than I have. I have been struggling with severe depression for about 7 years and severe socail anxiety for my whole adult life. My career, family, life is pretty much all down the river. Rebuilding has been a struggle. I have been through counseling and drug combo's over the past years. It seems I get a little help, then they poop out all together or I have severe reactions, like I did with Paxil. I am well into the "poop out" stage now and neither I nor my Dr's know where to turn. Depression symptons are building to a peak and the rebuilding of my life begins to seem pointless again. I have been on just about everyone of the newer antidepressants or a combination. My current cocktail is 20 mg Lexapro, 300 mg Wellbutrin XL, 30 mg of Remeron, 15 mg of Restoril for sleep and Klonopin to help with the anxiety. I have tried increasing the Remeron to 45, but I sleep with bizarre dreams and wake up with a hangover without the pleasure of a drink. Recently they tried to increase Wellbutrin XL to 450 mg and I was ready to crawl out of my skin. Same reaction I had to regular Wellbutrin. The only med. that I did not give a long term try is Cymbalta, I started then had to switch Dr's. and after being on it for three weeks they felt I was receiving no benefit. So I was onto Effexor. Effexor seem to be of some help with the depression for about 10 months.I have never received any crossover benefit for the anxiety from any of the new antidepressants. Only the benzo's seem to help me in that area and at this point, who cares about the addiction factor.
My current Doctor has been trying to talk me into ECT or even VNS. The VNS, I would not ever consider. Everyone that I have talked to about ECT, says that it is a temporary fix for those ready to whack themselves and there is short term and long term memory loss. My Dr. talks about like it is a Hip hollywood thing to do. Actually that is what he said. What can I say, he is Russian. I really think he is a plant for the KGB.
So gang, any suggestions on med changes? Anyone had positive experiance with switching to Cymbalta, ECT or switching from Klonopin to Xanax XR?
Sorry for writing so much, but I am really starting to struggle here.
Thanks!
E
Posted by Emily Elizabeth on August 5, 2006, at 17:38:31
In reply to Another Failed Med. Cocktail.....Help..Suggestions, posted by invisibleman15010 on August 5, 2006, at 13:20:02
Could you list what you have tried? It would help us brainstorm... Specifically, have you tried a TCA, MAOI, antipsychotic, lithium?
best,
EE
Posted by invisibleman15010 on August 6, 2006, at 10:31:03
In reply to Re: Another Failed Med. Cocktail.....Help..Suggestions, posted by Emily Elizabeth on August 5, 2006, at 17:38:31
As listed on my post; Wellbutrin XL 300mg, Lexapro
30 mg,Remeron 30 mg, Restoril 30 mg and Klonopin 1 mg 3-4 times a day. The only long term benefit, as with other meds combo is the benzo which does give me relief from anxiety and allows me to pursue socail situations, but now the depression is kicking in again so bad as before, I just don't give a ....it is a struggle to go the head doctor or go pick up my meds....I look at my resume, MBA thesis and just shake my head and toss em back in a pile.......This current cocktail like the rest has just quit after about 10 months. I know many of you have been through the same thing.I typed in ECT on the website and found some interesting insights...and arguements......they sound almost exactly like comments about specific meds...some say they are life savers, other say it almost killed them, like Paxil did to me. There were some specific stories mentioned that sounded just like mine; many meds. tried, ongoing struggle, no hope, and then struggle with the decision for ECT.......to me it sounds about the same as our meds....who knows what some of these are doing to us long term....look at the ones that have been taken off the market and the new warnings....I could just imagine getting the Vegas nerve implant, which I think is pseudo permanent, then here in 3 years that it is killing people.......at this point, it seems like a shot and a beer would work better!
The old class of meds. scare me to as I have talked to the head dr. about them. The potential side effects were well as bad if not worse than the current SSRI's etc........
Maybe St. Johns Wort and.......?
E
Posted by jedi on August 6, 2006, at 15:07:38
In reply to Another Failed Med. Cocktail.....Help..Suggestions, posted by invisibleman15010 on August 5, 2006, at 13:20:02
> Hi Group,
> It has been a few months since I have posted. I hope everyone has had more luck with treatment and meds. than I have. I have been struggling with severe depression for about 7 years and severe socail anxiety for my whole adult life.
...Hi,
If your depression is atypical, then your history of illness sounds very close to mine. I have been on over 35 different combinations of medications; the only thing that has worked for me is the MAOI Nardil combined with clonazepam. I too have suffered from social anxiety since I was in my late teens. Dysthymia has been a constant companion my entire adult life, though I was able to function at a high level until the first major depression hit about ten years ago. The only thing that has brought me out of at least four major depressions is Nardil. Everytime I have been off of the drug for any length of time, the depression has returned. As far as I'm concerned Nardil with clonazepam is the "Bomb" when it comes to atypical depression and social anxiety. For some of us it is the only medication that works. Yes, it is probably a little more dangerous than the newer meds; but not nearly so dangerous as major depression. Just my opinion.
Good Luck,
Jedi
Posted by invisibleman15010 on August 6, 2006, at 15:57:46
In reply to Re: Another Failed Med. Cocktail.....Help..Suggestions » invisibleman15010, posted by jedi on August 6, 2006, at 15:07:38
Jedi,
Thanks for the great info. Your story sounds so familiar to mine. I was able to struggle with the anxiety, using Xanax for work, presentations, meetings, etc. (pure hell...as I am sure you know)..and alcohol for socail situation...then my depression hit in my late 30's and it has ruined my life. I have lost all, I gave away almost all of my material pocessions, collections of art, antiques, sporting goods, a large civil war collection.....I just didn't care.......and don't again........I have had a few upbeat periods, but very little.....I am already on the Klonopin.....I will definately check out Nardil...I have heard of it and I think my Dr. talked about a few visits ago.....Jedi....could I ask, have you ever had ECT or considered it?
How are you faring now? Does the med. combo. keep you upbeat and functional?
What are the major drawbacks or Nardil???
Thanks so much!
E
Posted by jedi on August 7, 2006, at 0:31:38
In reply to Nardil/Klonopin Sounds Interesting???? » jedi, posted by invisibleman15010 on August 6, 2006, at 15:57:46
...
> Jedi....could I ask, have you ever had ECT or considered it?
> How are you faring now? Does the med. combo. keep you upbeat and functional?
> What are the major drawbacks or Nardil???
> Thanks so much!
> EHi E,
I am saving ECT for the last resort. From the research and comments I've read, it can pull you out of a major depression faster than anything. However that remission is often shortlived and repeat sessions are often necessary. I would consider it if the Nardil pooped out completely. Hopefully, if it ever comes to that, I could use ECT just to get back on my feet, then get back on high dose Nardil for maintenance.After more than ten years of fighting depression with so many different meds, my brain feels like mush sometimes. The daytime fatigue can really set me back. Before the depression hit I owned and managed a million dollar per year computer networking business. At the same time, I bought,sold, and managed more than 70 residential living units. Chronic, treatment resistant, depression took that all away. It really hurts to fall that far after working so hard to be successful.
Nardil with clonazepam keeps me from sleeping all day and from being in intense pain, in a fetal position, on the floor. It does not solve everything. The worst side effects for me are weight gain and a chronic afternoon fatigue. I've tried to get my MD to prescribe modafinil for the fatigue, but so far , No GO!
I don't think any medications are perfect. But when you can't even function, and are on the floor in a heap, something that can get you up and moving has to be good.
If you start Nardil, watch out for hypomania. The first couple of times on the med I mistook the hypomania with just feeling better. Sometimes you don't realize what is happening. When you can't even get out of bed, hypomania feels pretty good. I believe that atypical depression lies somewhere on the bipolar spectrum. This leaves you vulnerable to the switch to mania from antidepressants when not augmented with mood stabilizers.
Good Luck, I hope you give it a try.
Jedi
Posted by jedi on August 7, 2006, at 1:57:25
In reply to Re: Nardil/Klonopin Sounds Interesting???? » invisibleman15010, posted by jedi on August 7, 2006, at 0:31:38
Hi again,
I forgot to mention delayed ejaculation as a side effect of Nardil. For me, for about a month at high dosage (75-90mg), I sometimes can't ejaculate at all. After about a month this side effect subsides and then there is just some delay in ejaculation. For many guys, this is not necessarily a bad thing. I think communication with your partner is the important thing, so that she knows it is the medication that is causing the delay and not her. Viagra did nothing for me because erection is not the problem. Something about the drug, like some other antidepressants, just delays orgasm.
Jedi
Posted by invisibleman15010 on August 7, 2006, at 8:18:34
In reply to Re: Nardil/Klonopin Sounds Interesting????, posted by jedi on August 7, 2006, at 1:57:25
Jedi,
Hey..at this point I would be happy with a partner and the ability to get an erection......the remeron is a killer....I am going to start weaning myself off of it and maybe one of the others.....then surprise my psy doc....he usually does what I ask for anyway...funny if I don't have any issues...which I usually don't even want to bother with...as it seems like no hope....he starts writing the scripts before I am in the chair....$150 bucks for maybe 3 minutes....but he will listen......
delayed ejaculation.....hmm I'll take that over this state anyday......and thanks again for the suggestion......I am already digging for more info.
e
Posted by invisibleman15010 on August 7, 2006, at 8:30:14
In reply to Re: Nardil/Klonopin Sounds Interesting???? » invisibleman15010, posted by jedi on August 7, 2006, at 0:31:38
Jedi,
Great thanks! more good info...sounds so familiar.I too was running multi million business for major service contract companies (not owning though!)....and yes all gone.....and yes I know what the brain mush feels like.....I gained weight to about 30 lbs......though I eat an almost vegetarian diet....I am able to workout most mornings.....I have to force myself.....then after lunch I am done for the day.....Nap and then coffee.....I try to keep up reading...I can't seem to focus on tv for a long time...though there is anything to watch anyway....I don't know if I will ever get back the ability to focus on a project for 12 hour days and weeks at a time.......nothing seems to matter anymore....again man, thanks for the suggestions....thanks for sharing, it helps. I get
so sick of hearing from friends and family how things would be better if you could win the lottery or make a career move....blah blah....they don't understand unless they have been there....
I might consider ECT to get me out of this deep pit, and jump start me, then ask for parnate or Nardil for ongoing treatment.....I know I would have to stop the klonopin during treatment as it is also an anti seizure med......and go to something like Xanax...
e
Posted by blueberry on August 8, 2006, at 15:13:57
In reply to Another Failed Med. Cocktail.....Help..Suggestions, posted by invisibleman15010 on August 5, 2006, at 13:20:02
Just some ideas to ponder...
Top psychiatrists are now saying that antidepressant resistance and poopout is a sign of bipolar spectrum, even in the total absence of any mania. It is actually a bipolar that involves depression plus something else...the something else being anxiety and/or agitation and/or insomnia and/or poor antidepressant response.
That being said, you might consider strategies other than antidepressants. For example, choose your favorite antidepressant thus far and add to it zyprexa. Or lithium. Or depakote. For bipolar depression and for unipolar treatment resistant depression, prozac plus zyprexa has a good track record. In any case, get off the antidepressant bandwagon and go into areas that are new, whether they make sense or not. Logic says antidepressants are not the right mechanism, so something else must be.
It is just my opinion, but ECT should not be feared. It has a very high success rate. It also has a way of making medications work that previously did not work. The drawback of possible memory loss might not be a bad thing if there is a long depressed period in which it would be good to forget some things. Memory loss does not always happen though. ECT has a high relapse rate (about 50%), but that is where followup ECT treatments and/or medications play a role. And while many point to the high relapse rate, they fail to recognize that the relapse rate on medications is close to 100%. ECT plus medication followup has been highly recommended to me by a several different doctors and a handful of nurses. They had nothing but good things to say about it and how they've seen miraculous turnarounds. They don't make commission sales on it, so I don't think they had any hidden motive for being so supportive of it. They've just seen it work very well very often.
Posted by invisibleman15010 on August 8, 2006, at 15:53:37
In reply to Re: Another Failed Med. Cocktail.....Help..Suggestions » invisibleman15010, posted by blueberry on August 8, 2006, at 15:13:57
Blueberry, Thanks for the excellent info. Funny you mentioned ECT doesn't have any drug reps. out there pushing it, that is exactly what my Psy. doc said. He said, with a thick Russian accent"I am not going to make any more money by giving you ECT Treatment, actually it is more of a hassle, because I have to meet you at the hospital very early in the morning....etc."
I was actually thinking of asking to start ECT, with followup and restart Effexor XR with a Benzo..Effexor XR was the best run and longest run I have had so far, well over a year. The 4 antidepressants now, plus the benzos......is just not working at all....I am dead in the water....I want to start living, not continue dying.....
Jedi, had some good advice to about trying Nardil or Parnate if the antis did not work any longer. The MAOI's scare list does just that, scare me. That is almost one of the reasons why I think I quit Effexor was all of the horror stories about getting off of it.(Babble info Overload) Actually I had no trouble, and in the end I was emptying the little pills out of the capsules until I was down to zero. I have been through so many med changes and life crisis over the past few years, I don't remember why I quit each. Though I do remember the horrible reaction to Paxil and Zoloft. Thanks again guys, I feel better about approaching my Psy doc., when I have good info going in, they don't usually get that. I have found that writing him a letter before hand and copying my therapist has been very beneficial, as I tend to forget once I get in any hospital/ clinic enviroment.....more anxiety ...oh my!
Thanks again so much. Bless you all!
Posted by Deniseuk190466 on August 13, 2006, at 15:15:19
In reply to Another Failed Med. Cocktail.....Help..Suggestions, posted by invisibleman15010 on August 5, 2006, at 13:20:02
Hi,
Just wanted to say don't be scared of the old meds, especially not the tricyclics. The first ever antidepressant I took was a tricyclic and I had absolutely no side affects on it at all. I then went on later to take SSRIs and if anything I had more side affects on them although they did work wonderfully (back then).
As for the MAOI I've taken Nardil this time around and although I did have bad (mental) side affects on them, I didn't really have any phsyical side affects.
I like you keep deliberating about and reading up on ECT and the more you read the more you confused you get as you get such mixed messages. The thing is my psychiatrist won't let me have it anyway, I wish he would because I might give it a try.
I have to say I have found help with antipsychychotics, Zyprexa does help my mood at times but I only take it when I'm desperate.
Kind regards.....Denise
Posted by invisibleman15010 on August 13, 2006, at 16:21:08
In reply to Don't be scared of old meds, no worse than SSRIs, posted by Deniseuk190466 on August 13, 2006, at 15:15:19
Denise,
Thanks........It is a crap shoot and hopefully we don't end up with a mind of crap. I know there is no "happy pill".....well at least legal....I already wrote a letter to my Psy. Doc and therapist, asking for ECT and then retry Effoxor XR or many Cymbalta. If those don't work, then I will ask for maybe Parnate or Nardil. I have better luck putting my thoughts in writing and dropping them off before I go into "the office" and sit on the other side of the desk and forget everything I wanted to say. I will post if I do get the ECT and a med change and how I progress.
e
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