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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by dondon on September 30, 2006, at 20:38:21
FOr those of you that have treatment resistant depression... what combo of meds finally worked for you?
Posted by SLS on October 1, 2006, at 1:04:16
In reply to treatment resistance what has worked for you?, posted by dondon on September 30, 2006, at 20:38:21
> FOr those of you that have treatment resistant depression... what combo of meds finally worked for you?
Parnate 60mg + desipramine 150mg
- Scott
Posted by foreigner on October 1, 2006, at 3:25:38
In reply to treatment resistance what has worked for you?, posted by dondon on September 30, 2006, at 20:38:21
Stablon(tianeptine) 12.5mg*2 +vitamin and minerals + not to bother about the future much:)
I can recommend all treatment resistant people to give a chance to tianeptine. It isn't a miracle drug but It doesn't allow you to go to edges (for some people).
Posted by tensor on October 1, 2006, at 5:04:53
In reply to treatment resistance what has worked for you?, posted by dondon on September 30, 2006, at 20:38:21
I have had several combos that have worked, the best one so far is remeron + nortriptyline.
/Mattias
Posted by djmmm on October 1, 2006, at 8:11:09
In reply to Re: treatment resistance what has worked for you? » dondon, posted by tensor on October 1, 2006, at 5:04:53
A couple of combos have worked well for me
nardil + neurontin + topamax + inderal
or..
Parnate + Klonopin
Posted by SLS on October 1, 2006, at 8:58:59
In reply to Re: treatment resistance what has worked for you?, posted by djmmm on October 1, 2006, at 8:11:09
> A couple of combos have worked well for me
>
> nardil + neurontin + topamax + inderal
I may give Nardil + Topamax a try.Good idea. Why did you stop it?
I would leave my other drugs in place if my doctor allows it. I am going to have a difficult time keeping the nortriptyline. I think there is a 50/50 chance that it will produce a mild serotonin syndrome, but I want to try it anyway.
Currently:Lamictal 150mg
nortriptyline 100mg
Topamax 100mg
Lyrica 600mg
Abilify 10mg
- Scott
Posted by Phillipa on October 1, 2006, at 11:25:09
In reply to Re: treatment resistance what has worked for you? » djmmm, posted by SLS on October 1, 2006, at 8:58:59
None and today the upped luvox has my brain thinking suicide although I won't. Just don't know how to control the thoughts and no hospital for me and the pdoc is too far away. Oh well. Love Phillipa
Posted by jaclinhyde on October 1, 2006, at 17:18:07
In reply to Re: treatment resistance what has worked for you?, posted by Phillipa on October 1, 2006, at 11:25:09
Parnate/Nardil/Marplan + neurontin + Klonopin
Terri
Posted by Another Phil on October 1, 2006, at 22:31:25
In reply to Re: treatment resistance what has worked for you?, posted by jaclinhyde on October 1, 2006, at 17:18:07
Selegiline/Emsam 6 mg + Zyprexa 5 mg. I couldn't stay on the Emsam because of the severe problems it was causing with my concentration.
Currently, my mood is quite good on Parnate 80 mg + 50 mg Lamictal. However there are two (maybe three) lingering side effects that may make this unworkable for me long-term.
(1) Insomnia. I've tried several things and haven't had much success. Trazadone and Seroquel allowed me to fall asleep but I wouldn't stay asleep for long. Ambien and Lunesta (at higher than recommended doses) do the trick for sleep, but both make me really depressed again (as in, crying hysterically). I've also tried Valerian root with no luck.
(2) *Brutal* constipation. I can eat a pound of prunes a day and still...nothing...for 4-5 days at a time. I've found some laxatives that work, but the prospect of using laxatives daily for months or years seems like an invitation for various lower digestive diseases.
(3) Weight gain. I know I'm really vain. It's only 10 lbs. and doesn't seem to be increasing any more than that. I think I gained the weight earlier this year while taking Neurontin for sleep while on Emsam. But now that I'm off that and on Parnate (which often causes people to *lose* weight). I can't seem to lose the extra pounds, even though I work out every other day, have a healthy diet, and don't eat excessively.
Sorry if this was more than you asked for. The point is that after years on various antidepressants & adjucts, I *have* found treatments that work for my depression. I just haven't found the magic combination that works for my depression AND has I side-effect profile that I've been able to live with for more than a few months at a time.
Getting up to my current dose of Parnate was pretty traumatic, so I'm reluctant to just give it up. But I also know that I can't live with the insomnia and constipation indefinitely.
Phil
Posted by Jost on October 1, 2006, at 23:25:50
In reply to Re: treatment resistance what has worked for you?, posted by Another Phil on October 1, 2006, at 22:31:25
Hi, Another Phil.
I was wondering how long you were on Emsam before you discontinued, and also how quickly you increased on Parnate.
I'm trying to figure out a problematic reaction I had to Emsam, and am hoping to go back onto it. So I"m somewhat interested in how long people stayed on Emsam, and at what dosage, and also how they did as they discontinued (ie did your mood shift dramatically downward or stay the same, or even improve for a while after discontinuing).
I also had taken Parnate previously, and may have gained a few pounds (not sure, my weight sometimes varies by a few pounds). Parnate tends not to cause weight gain, but my Pdoc mentioned that those who gained weight usually didn't gain more than about 8 pounds. It does happen, rarely, but you might not gain more, in his experience.
Hope that's how it goes for you.
Jost
Posted by Another Phil on October 1, 2006, at 23:49:22
In reply to Re: treatment resistance what has worked for you? » Another Phil, posted by Jost on October 1, 2006, at 23:25:50
I was taking oral Selegiline for about two months before starting Emsam. I started Emsam in late March (I think) and finally stopped at the beginning of July. I was pretty frantic at that point because the problems it had cause with my concentration had left me with a stack of to-do lists that were obviously never going to get prioritized or done. So since I was so crazed at that point, my pdoc had me just stop the patch one day, then start with 10 mg of Parnate the next.
My Parnate story is a pretty long one, but I'll try to summarize. I increased to 30 mg/day in a few days, and immediately, I felt "great." I didn't realize at the time that I was hypomanic (sucking down a can of diet coke, then announcing to everyone around me "that was delicious!"). I just felt so good that I didn't bother thinking about what might happen next. About two weeks later, I crashed really hard. I was severly depressed (probably should have been hospitalized, but I was lucky to be able to have my mom stay with me for a few days). My pdoc then had me ramp up to 60 mg/day over the next few days, then 80 mg the next week. The problem was that I was waking up every morning crying and depressed, then after my second dose of Parnate at about noon, I'd start to feel OK. So...we added a mood stabilizer (first Depakote, which was a miserable experience; now Lamictal, which is OK). So, I'm feeling OK. No wild mood swings. But I'm not crazy about having medication-induced bipolar-like symptoms, then treating them with a mood stabilizer. (What could possibly go wrong with this in the future? right?) Not to mention the ongoing insomnia and killer constipation.
Phil
Posted by Jost on October 2, 2006, at 11:02:10
In reply to Re: treatment resistance what has worked for you?, posted by Another Phil on October 1, 2006, at 23:49:22
Wow, APhil, that sounds pretty tough. You ,must be a real survivor to have made through that particular psychopharmocological rockclimb.
Could it be that the combination of Emsam and Parnate pushed you over the edge, given that the Emsam wasn't at all out of your system?
If so, maybe things will even out over time. It's been while, but I noticed that once you get thrown into a strong reaction, it can take a long time for your neurotransmitters to readust and create the new more permanent, and, one hopes, stable, level and interaction.
When I went off Parnate (about a year and a half ago) not cold turkey, but almost, I got very depressed, but with wild fluctuations of mood, with an almost manic feeling at times. It was very tough, and took at couple of months to become more normal (normal not necessarily being good, but a lot better than that).
Your Pdoc must be very comfortable with Maois to go for that course-- many approach them with diffidence, if not dislike.
At what point, would you say, you got to the mix of meds you're using now? about the middle-end of August? cause that really isn't that long, when you're talking about changing so many intense drugs, with such rapidity.
Btw, do you do all the usual things re: constipation, that you might not have to do, but that are simple, like drinking enough water (v.important) and eating bran (or something with lots of insoluble fiber). I've had experience with someone who had a severe problem in that respect, and it can be hard to treat. But let me know if you need any (not medical, but at least experienced) advice.
Jost
Posted by pseudoname on October 2, 2006, at 15:30:23
In reply to treatment resistance what has worked for you?, posted by dondon on September 30, 2006, at 20:38:21
Hi, dondon.
buprenorphine (Subutex). It's an opioid that's usually given to opioid addicts in recovery programs, but it was a life-saver for me. It's hard for non-addicts to get it, though.
More on buprenorphine for depression at Babble-Tips: http://health.groups.yahoo.com/group/psycho-babble-tips/links/buprenorphine_for_de_001146748536/
Posted by dondon on October 2, 2006, at 18:31:52
In reply to Re: treatment resistance what has worked for you?, posted by SLS on October 1, 2006, at 1:04:16
I was on paxil and wellbutrin and had a partial response but when i added lamotrigine I had a dramatic increase in my mood. I looked up some info on lamotrigine and found out that it is great for treatment resistant depression.
Posted by Phillipa on October 2, 2006, at 18:47:55
In reply to Re: treatment resistance what has worked for you?, posted by Another Phil on October 1, 2006, at 23:49:22
Phil take a magnesium pill at night I always do. Love Phillipa ps I have hemmoroids can't get constipated.
Posted by Another Phil on October 2, 2006, at 23:08:15
In reply to Re: treatment resistance what has worked for you? » Another Phil, posted by Jost on October 2, 2006, at 11:02:10
> Could it be that the combination of Emsam and Parnate pushed you over the edge, given that the Emsam wasn't at all out of your system?
I suspect that that contributed to it. Also, I had just tapered off of a relatively low dose of Effexor about a week earlier. Even though Effexor has a very short half life, I don't know how long after discontinuing it its effect on neurotransmitters persists. (See my complaints about my pdoc, below).
> If so, maybe things will even out over time.
Actually, things have evened out quite nicely for me (with the obvious exception of the side effects I mentioned). I'm back to working out and running every other day, which was unimaginable while I was sick from the Depakote side effects.
> Your Pdoc must be very comfortable with Maois to go for that course-- many approach them with diffidence, if not dislike.
Apparently, he has a fantastic reputation; since everyone I've spoken to in his field seems to have heard of him and thinks highly of him. However, he has done several things over the past few months to make believe that he's a bit reckless, cavalier about MY side effects, and, maybe not as knowledgeable as his reputation suggests. I can post details if anyone is interested; it's probably not relevant though. I have gotten recommendations for another Pdoc from several sources and will try to get an appointment with him soon, if for no other reason than a second opinion.
> At what point, would you say, you got to the mix of meds you're using now? about the middle-end of August? cause that really isn't that long, when you're talking about changing so many intense drugs, with such rapidity.
That's about right. The daily cycling stopped when I started taking Depakote, but since I had been so miserable before, I didn't realize that the Depakote was causing all sorts of other side effects, basically making me feel weak and ill all the time. Once I replace it with Lamictal (probably late August), I felt immediately better.
> Btw, do you do all the usual things re: constipation, that you might not have to do, but that are simple, like drinking enough water (v.important) and eating bran (or something with lots of insoluble fiber). I've had experience with someone who had a severe problem in that respect, and it can be hard to treat. But let me know if you need any (not medical, but at least experienced) advice.
Yes. I've done it all. Nothing seems to work but laxatives: a combination of peri-colace and magnesium-based laxatives.
Thanks for the concern and advice. Let me know if I can tell you anything else that might help you.
Posted by sregan on October 5, 2006, at 16:13:58
In reply to Re: treatment resistance what has worked for you?, posted by foreigner on October 1, 2006, at 3:25:38
> Stablon(tianeptine) 12.5mg*2 +vitamin and minerals + not to bother about the future much:)
> I can recommend all treatment resistant people to give a chance to tianeptine. It isn't a miracle drug but It doesn't allow you to go to edges (for some people).Is tianeptine in any form available in the US currently?
Posted by pseudoname on October 5, 2006, at 16:48:41
In reply to Re: treatment resistance what has worked for you? » foreigner, posted by sregan on October 5, 2006, at 16:13:58
Hi, sregan.
> Is tianeptine in any form available in the US currently?
Not really. See http://www.dr-bob.org/babble/20061003/msgs/692034.html, from this morning for a good summary.
Posted by psychobot5000 on October 5, 2006, at 23:04:38
In reply to Re: treatment resistance what has worked for you?, posted by Another Phil on October 2, 2006, at 23:08:15
> Apparently, he has a fantastic reputation; since everyone I've spoken to in his field seems to have heard of him and thinks highly of him. However, he has done several things over the past few months to make believe that he's a bit reckless, cavalier about MY side effects, and, maybe not as knowledgeable as his reputation suggests. I can post details if anyone is interested;
I'd like to hear the details of this doc, if you wouldn't mind--I've dealt with enough docs I think over-cautious, that reckless doesn't sound too bad, right now. :)
Posted by Questionmark on October 6, 2006, at 19:57:21
In reply to Re: treatment resistance what has worked for you? » Another Phil, posted by psychobot5000 on October 5, 2006, at 23:04:38
Nardil, 60mg.
This is the end of the thread.
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