![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by stargazer on November 1, 2006, at 11:32:58
My doctor is telling me he is treating some patients with seroquel alone successfully. I knew it was just approved for BP but wasn't familiar with treating MDD with it.
I know it's more the symptoms which are treated than the diagnosis so I guess this makes sense, right?
Anyone having luck with this? What dosage? How long?
I started seroquel 25 mg on 10/30. Tonight I'll increase to 50 mg. I'm also on Cymbalta 30 mg (couldn't go any higher than 30 d/t headaches)since I had already been on that but I think the plan is to stop that (or not) down the road.
SG
Posted by Phillipa on November 1, 2006, at 11:46:06
In reply to SEROQUEL...monotherapy for Depression?, posted by stargazer on November 1, 2006, at 11:32:58
Stargazer my pdoc also gave me a bunch of samples of seroquel and wants me to take it for depression and anxiety too. But I also have to take the valium as she said from all the years benzos don't work for me. I don't understand how an antipsychotic can be mono for depression. I need and want to know. So glad you asked this question. Love Phillipa
Posted by yxibow on November 1, 2006, at 13:44:05
In reply to SEROQUEL...monotherapy for Depression?, posted by stargazer on November 1, 2006, at 11:32:58
> My doctor is telling me he is treating some patients with seroquel alone successfully. I knew it was just approved for BP but wasn't familiar with treating MDD with it.
>
> I know it's more the symptoms which are treated than the diagnosis so I guess this makes sense, right?
>
> Anyone having luck with this? What dosage? How long?
>
> I started seroquel 25 mg on 10/30. Tonight I'll increase to 50 mg. I'm also on Cymbalta 30 mg (couldn't go any higher than 30 d/t headaches)since I had already been on that but I think the plan is to stop that (or not) down the road.
>
> SG
Its best as augmentative therapy for depression as augmentative for anxiety disorders but as I've noted, it, like Remeron, forms a serotonin blockade on certain key receptors, in a way that other antidepressants are normally reuptake inhibitors.So one could use it as monotherapy but I wouldn't use personally any neuroleptic until I've tried the usual cast of SSRI/SSNRIs/TCAs (and possibly MAOIs -- gasp).
Augmentative the dose would be lower because its synergistic with another medication, as monotherapy the dose I am only surmising would have to be much higher subjecting one to greater EPS.
The tradeoff is that as an offlabel antidepressant it works much faster, things like Zyprexa, Seroquel, etc, within a week can lift spirits.
-- tidings
Jay
Posted by stargazer on November 1, 2006, at 15:00:01
In reply to Re: SEROQUEL...monotherapy for Depression? » stargazer, posted by yxibow on November 1, 2006, at 13:44:05
Phillipa/Jay,
Have tried most of the other AD's inc MAO's. My only experience with TCA's was in the mid 80's pre-Prozac (dating myself) and had severe anticholinergic SE's, dry mouth, dilated pupils, making me look like a drug addict.
My current pdoc has not ever suggested a trial w TCA's even though he was not the Rx'ing MD back then. Not sure if they would be worth a try but perhaps I should mention to him.
His plan for now is...see what seroquel does...told me to increase it every day as long as I am not having SE's that prevent this. Since I am also on Cymbalta, not sure if he will just keep me on this anyway. He also wants me to try Ensam next (w 2 week washout) if I do not respond to the seroquel trial.
My best response was to Nardil and Marplan but I did not respond to repeat trials with these. Just finished a trial w Marplan, at my insistence, with minimal results. I'm not sure how closely the newer release of Marplan was similar to it's original chemical composition.
Today on day 2 of seroquel 25mg I feel pretty good, I actually was able to do some minor projects around the house, whereas last week I was in and out of bed most days with no motivation to do anything, even eat.
SG
Posted by ed_uk on November 1, 2006, at 15:59:44
In reply to Re: SEROQUEL...monotherapy for Depression?, posted by stargazer on November 1, 2006, at 15:00:01
Which tricyclic(s) did you try? There are differences between the various TCAs.
Ed
Posted by stargazer on November 1, 2006, at 16:13:52
In reply to Re: SEROQUEL...monotherapy for Depression? » stargazer, posted by ed_uk on November 1, 2006, at 15:59:44
Ed,
Interesting question...which TCA...it was so long ago, I think it was Elavil...I also took Sinequan for awhile, not sure if that was a TCA...again I'm stretching my memory reserves, it was perhaps 1987 or 1988... and believe it or not...I had to ask for medication after suffering for 2 years talking (rather crying to) to a therapist, who was concerned about me being suicidal...I said I think perhaps I need
medication, and that was where this search began.Does anyone have good results with the TCA's, it doesn't seem like they are ever mentioned anymore. Perhaps I should try one before I go right to Ensam. I'll ask my pdoc next Monday.
SG
Posted by Lindenblüte on November 1, 2006, at 21:30:32
In reply to Re: SEROQUEL...monotherapy for Depression? » stargazer, posted by yxibow on November 1, 2006, at 13:44:05
Hi Stargazer,
My pdoc put me on 300mg seroquel. I'm not bipolar depressed, just major depressed, in need of some mood stabilization. I've got intrusive thoughts too. Pdoc said good evidence for seroquel being effective AD, even though the studies have been done on bipolar depressed folks.It's awfully nice to get intrusive thoughts a ticket OUT of my mind. Little loops of anxious thoughts that go on for hours and hours are quiet. nothing.
It wasn't enough, though. even augmenting my 90mg cymbalta, that I had been on for 4 mos. now I've increased my cymbalta to 120mg.
cymbalta sedates me like crazy, though. At least on seroquel the sedation went away once I woke up in the am (even if I didn't wake up until 11am). also, on seroquel, I got used to the sedation after about a week at 300mg. Hang in there.
I'm already feeling better, by the way. Gotta say. no crying in a while, not as anxious. not as many triggers. only a little hint of suicidal thoughts about once a day or 3.
improving.
hope everyone can join me improving.
HRH PoPpp
Li
Posted by stargazer on November 2, 2006, at 8:55:43
In reply to Re: SEROQUEL...monotherapy for Depression?, posted by Lindenblüte on November 1, 2006, at 21:30:32
Li (chemical abbreviation for Lithium, LOL)
Hi, interestingly, we both take Cymbalta and Seroquel but at extreme opposite dosages,which I find quite curious. I have always had better results at subtherapeutic levels and I have often challenged my pdoc to allow me to stay at much lower levels than thought were indicated. I have often thought many of my med failures may have been related to overshooting the "therapeutic window" for a given AD.
Cymbalta gave me a headache at 60 mg, so I'm at 30 mg, which suits me just fine. I have never had a great response to SSRI's or SSNRI's, which initially feels better than a depressed affect, but usually makes me feel like only an "observer" of the world.
Last night I increased Seroquel to 50 mg and today feel OK, not really any appreciable difference from 25 mg. I doubt I will get anywhere near to the level you are currently at, which is fine with me as long as it is working and not giving me SE's.
I do agree that Seroquel reduces ruminative thoughts of worthlessness, SI and other negative messages, although there are no real feelings of hope yet. I'm grateful that I haven't given up but I'm depressed about life being on hold again.
SG
Posted by linkadge on November 2, 2006, at 10:39:23
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by stargazer on November 2, 2006, at 8:55:43
The theraputic doses are probably a good multiple of what is required for a lot of people. The drug companies need you hooked.
Linkadge
Posted by Lindenblüte on November 2, 2006, at 10:55:49
In reply to Re: SEROQUEL...monotherapy for Depression?/Li » stargazer, posted by linkadge on November 2, 2006, at 10:39:23
Well, I was on 25-50 for about 5 months.
Now I'm on 300. My symptoms have gotten better, even though I did need to boost my AD as well.
I don't want to minimize the effects of conflicts of interest on drug research, but the studies finding AD effects of seroquel used 300 mg. bipolar and schizophrenia neuroleptic doses even higher. 800-1200 mg.
I'm bothered by the notion that pdoc and Lindenb. are mere marionettes of the drug companies. That I am "hooked" suggests that I am dependent, in a bad way. Do you mean to suggest that I am addicted to seroquel?
It's important to me that I feel like I'm in control of my own treatment. I've been a victim for too long.
And of course I would always advocate using as small a dose as possible, especially with a neuroleptic drug like seroquel.
I basically use meds to augment my psychotherapy, which is going well. Right now, I'm working on some really awful stuff in therapy, and it's very very anxiety producing, and causes me to have extreme emotional reactions which are impairing my ability to do work, sleep, live, love. Having survived my past, (which was the hard part) I now have to learn how to survive my present- where I'm confronted for the first time with the emotional sequelae of those events that I was unable to process earlier. My psyche is protecting itself from the intense feelings by essentially shutting down (depression).
I just wanted to tell a little bit more about my person so that I can communicate why autonomy is so important. I'm vulnerable to being victimized right now, and I have to be vigilant. Don't need any more trauma, implied or otherwise.
-Li
Posted by linkadge on November 2, 2006, at 15:57:56
In reply to Re: SEROQUEL...monotherapy for Depression?/Li » linkadge, posted by Lindenblüte on November 2, 2006, at 10:55:49
I'm not here to put anyone down, and of course everyone's case is different.
There have been assertions though, that some clinical trials show lower doses of certain drugs work as well if not better, than higher doses.
I am also willing to bet that length of time spent as a drug consumer is proportional to dose.
People on 450mg of effexor are going to be on the drug a lot longer than somebody on 37.5 mg.
That being said, don't let my paranoia get in the way of your recovery.
Linkadge
Posted by deniseuk190466 on November 2, 2006, at 16:10:06
In reply to SEROQUEL...monotherapy for Depression?, posted by stargazer on November 1, 2006, at 11:32:58
Well 10mg of Zyprexa always seems to help my depression either on it's own or added to SSRIs although I must admit it seems to work better with an SSRI.
I don't think it works by it's action on 5HTP3 receptors because I've also (and am trying Mirtazapine/Remeron and it does nothing for my depression.
My gut feeling about Zyprexa is I'm getting an antideppressant affect because of it's affect on the dopamine receptors. When I take it I can definitely feel stimulation at the front of my brain. I used to feel this sort of stimulation years ago when I responded well to just ADs.
Denise
Posted by Lindenblüte on November 2, 2006, at 16:10:28
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 2, 2006, at 15:57:56
People who spend longer times on medication tend to have more complicated circumstances than people with a fairly straightforward single diagnosis and no comorbidity.
I'm comorbid. *grin*
And I'm addicted to being me.
-Li
Posted by Phillipa on November 2, 2006, at 18:31:11
In reply to Re: SEROQUEL...monotherapy for Depression?/Li » linkadge, posted by Lindenblüte on November 2, 2006, at 16:10:28
Is seems that once you're on a med you're on one for life. I use myself as an example. In my 20's valium for anxiety. Now I'm becoming tolerant and no pdoc will give me higher doses. I'm faced with staying basically nonfunctional in the world at my age to trying a med that may cause me more health problems. As the atypical antipsychoics seem to be leading to a lot of diaabetes. And back when valium was the thing what doc would have ever let it cross his mind that they might be addiciting? They just worked. So what is next? Love Phillipa ps my Daughter is taking seroquel to sleep and after only a few weeks is afraid to stop it as she fears waking up and not being able to sleep so to me this is addictive to. I just don't know what to think anymore.
Posted by linkadge on November 2, 2006, at 19:00:32
In reply to Re: SEROQUEL...monotherapy for Depression?, posted by deniseuk190466 on November 2, 2006, at 16:10:06
There are other actions of zyprexa which may help your depression. Zyprexa has a strong gabergic effect, for instance.
Linkadge
Posted by linkadge on November 2, 2006, at 19:05:51
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by Phillipa on November 2, 2006, at 18:31:11
Well, I'm not going to start this rant since it always hits a cord with a lot of people.
Meds are addicting, they stop working, they fry your brain, they leave you worse off than when you started.
There I got it out, no no more from my lips.
Linkadge
Posted by Phillipa on November 2, 2006, at 19:24:54
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 2, 2006, at 19:05:51
No Link there are two sides to everything. You make me question things very important. Love Phillipa
Posted by Lindenblüte on November 3, 2006, at 8:41:04
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 2, 2006, at 19:05:51
I'm glad you got the rant out of your system for the moment.
I guess in addition to being "addicted" to meds, I'm "addicted" to water, fresh air, calories, hugs, music...etc.
If meds left me worse off than when I started, I would be dead by now. At the time when I started meds for the first time, I was fairly certain that would not live another month.
so? maybe I've done some good stuff with my life in the last 6 months. These are things that I would not have been able to do if I were not in treatment for my depression.
I think depression fries a lot of brains too.
-Li
Posted by linkadge on November 3, 2006, at 10:00:44
In reply to Re: SEROQUEL...monotherapy for Depression?/Li » linkadge, posted by Lindenblüte on November 3, 2006, at 8:41:04
Just to play the devils advocate, I think that if you were going to kill yourself you would have already. Antidepressants have not statistically altered the rate of suicide since their introduction.
Being addicted to a drug does is not always directly apparent right away.
The connotation of *addiction* sounds so harsh. You are right, we are addicted to air. I guess the real acid test is wheather the drugs continue to work for you. I define my experience as one of addiction owing to the fact that the drugs stopped working. In this case, I was faced with a regular pattern of tollerance and dose escalation in order to acheive the same effect. This is why I think of my case as being addicted to antidepressants.
Again, my disclamer is that I really don't know your case, and I am trying to rant in as general a sense as possable.
Linkadge
Posted by stargazer on November 3, 2006, at 13:52:37
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 3, 2006, at 10:00:44
Interesting dialogue ...I like the way both of you have kept it impersonal but have gotten your points made for and against medications. I would love to not take meds and have tried to do this several times but the depression always returns. I will say that I have NEVER felt addicted to them but have only been on modest dosages. My tolerance for meds is very low.
I'm at 50 mg seroquel as of last night, tonight I go to 100 mg. I am not noticing that much of a sedative effect, like I thought I would. I wish I was off the Cymbalta since I cannot truly say what is the effect of the Cymbalta and what is the effect of the seroquel. But on Cymbalta alone, before seroquel, I felt pretty miserable so seroquel must be doing something positive for me.
On one hand I have more motivation and my appetite has improved but I remain with a feeling of lightheadness. I think it is the effects of Cymbalta. If I can eliminate the Cymbalta then I will know what seroquel alone is doing. This may happen at my next pdoc appt Monday, as long as he feels Cymbalta is doing nothing.
Ensam would be the next AD if seroquel alone doesn't do the trick.
Posted by Lindenblüte on November 3, 2006, at 16:43:01
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 3, 2006, at 10:00:44
> Just to play the devils advocate, I think that if you were going to kill yourself you would have already. Antidepressants have not statistically altered the rate of suicide since their introduction.
I am not aware of these statistics. Could you provide a citation? I'm not sure that I feel comfortable arguing this point with you until I've evaluated the research you refer to.
> Being addicted to a drug does is not always directly apparent right away.
yes, of course. good point. i'm biased in favor of pharma and everything else I'm doing at the moment since I am feeling a little better every day. so, I may be the voice of ADDICTION, rather than a sane voice of impartial reason.
> The connotation of *addiction* sounds so harsh. You are right, we are addicted to air. I guess the real acid test is wheather the drugs continue to work for you. I define my experience as one of addiction owing to the fact that the drugs stopped working. In this case, I was faced with a regular pattern of tollerance and dose escalation in order to acheive the same effect. This is why I think of my case as being addicted to antidepressants.
Tom Wolfe "The Electric Kool-Aid Acid Test". An interesting example to throw some color into the mix. I think it's interesting to view "addiction" through a cultural lens. For example, my friend G is terrified of becoming dependent or addicted to any person or substance. She even eschews lip balm, romance, caffeine and other creature comforts. I'm not at all convinced that her choices have made her happier or more satisfied. Some religions consider the use of intoxicants wrong, and discourage devotees to avoid substances that act as intoxicants.
I'm not sure if the drugs work for me. I suppose I have been feeling more hopeful, and I'm able to get more pleasure out of simple things like food and sex and sunshine. These are all very subtle things that unfolded over months. Months that were accompanied by major lifestyle changes, psycho-therapy, nutritional changes, etc. And the meds are one piece of the puzzle. I'm pretty sure that if I went off of them (especially cold-turkey!) I would feel like utter sh*t.
This is not unique to psych meds, though. Yesterday evening I didn't drink enough water. I felt thirsty for 8 hours and for various reasons was unable to obtain any liquids before bed. My pee was a not-happy color in the am, and I had headache and felt like crap. I guess I'm hooked on water. ((((hydration)))). I probably don't need to keep on increasing my amount of water though, to feel satiated. Fortunately, my kidneys and brain have evolved in such a way to provide good feedback about thirst. But-- what if the signals become mixed up in the hypothalamus- and instead of "thirst" we feel "munchies"? We eat more food, our blood becomes even thicker, more saline, and we are left with ... even more munchies! Hopefully one would wise-up at this point and reach for a glass of H2O, but-- what if your psychology never allowed you to make this connection? Would you keep on eating and eating and eating until?
> Again, my disclamer is that I really don't know your case, and I am trying to rant in as general a sense as possable.That's fine Linkadge, and I respect your candor. Although I must admit that I was kind of shocked by your opening sentence. A sick and twisted depressed Li would view that as a "challenge". Luckily I'm a well-hydrated, exercised, Omega-three-ed and cognitively stimulated Lindenbluete.
And I'm really sorry to hear that the drugs did not give you a long-term improvement. Sometimes having an instability (getting better-getting worse-getting better-getting worse) is more damaging to the psyche that a low-level feeling yucky. I hope you won't give up on other ways to obtain relief- perhaps through lifestyle changes, seeing a therapist or alternative treatments.
>
> Linkadge-Li
Posted by linkadge on November 3, 2006, at 18:46:01
In reply to Re: SEROQUEL...monotherapy for Depression?/Li » linkadge, posted by Lindenblüte on November 3, 2006, at 16:43:01
>I am not aware of these statistics. Could you >provide a citation? I'm not sure that I feel >comfortable arguing this point with you until >I've evaluated the research you refer to.
I'll babblemail you the link, since Dr. Bob banned the page because it has some links to how to obtain drugs without a prescription.
>yes, of course. good point. i'm biased in favor >of pharma and everything else I'm doing at the >moment since I am feeling a little better every >day. so, I may be the voice of ADDICTION, rather >than a sane voice of impartial reason.
I'm just saying that drugs (even prescription drugs) can be great till its time to come off. But then why would you want to come off it if its working right? Because it may stop working for you. Not saying it will. Just saying that this seems to happen to a lot of people thats all.
When people say, I know my drug was working because when I tried to come off I felt like crap. Well that logic only kindof works, since the brain recruits systems to oppose drug action when the drug is being taken. When the drug is discontinued, these systems work, unopposed for a period of time, leaving you with withdrawl which is hard to distinush from ones originial condition.>Tom Wolfe "The Electric Kool-Aid Acid Test". An >interesting example to throw some color into the >mix. I think it's interesting to >view "addiction" through a cultural lens. For >example, my friend G is terrified of becoming >dependent or addicted to any person or >substance.
Well, we're all addicted to something. It obviously creates a lot of confusion, and turmoil about the decision to take medications. If I could go back I woudn't have taken medications, but thats just because I still havn't learned to walk straight after discontinuing zyprexa + zoloft. Withdrawl was hell, and it lasted forever. For a long time, I was worse than before I started.
>I'm not sure if the drugs work for me. I suppose >I have been feeling more hopeful, and I'm able >to get more pleasure out of simple things like >food and sex and sunshine. These are all very >subtle things that unfolded over months. Months >that were accompanied by major lifestyle >changes, psycho-therapy, nutritional changes, >etc. And the meds are one piece of the puzzle. >I'm pretty sure that if I went off of them >>especially cold-turkey!) I would feel like >utter sh*t.
You might, and thats why its not my purpose to tell anyone what do do. I can tell people what I think, and how drugs affected me, but thats all.
For me, my life was crap. Drugs made me forget that for a little while, but my life is still crap, they did not change that.>I guess I'm hooked on water. ((((hydration)))). >I probably don't need to keep on increasing my >amount of water though, to feel satiated.
Its really about context. Take effexor withdrawl for instance. Effexor withdrawl for some, is so severe that it can ruin doctor patient relationships. When you take methamphetamines, it is very hard to believe that something that makes you feel so good, could be so bad. Its the same thing with antidepressants. They make you feel good, so the tendancy is to believe all the good stuff you hear, and discredit the bad stuff. If you ever decide to discontinue, then obviosly I hope you have a smooth transition, but that is the only context during which one can truely *sses the adiction potential (in my opinion).
>That's fine Linkadge, and I respect your candor. >Although I must admit that I was kind of shocked >by your opening sentence. A sick and twisted >depressed Li would view that as a "challenge". >Luckily I'm a well-hydrated, exercised, Omega->three-ed and cognitively stimulated Lindenbluete.
You must understand that I have these kind of debates all the time here on babble. With SLS, and others. I have nothing against you.
>And I'm really sorry to hear that the drugs did >not give you a long-term improvement. Sometimes >having an instability (getting better-getting >worse-getting better-getting worse) is more >damaging to the psyche that a low-level feeling >yucky. I hope you won't give up on other ways to >obtain relief- perhaps through lifestyle >changes, seeing a therapist or alternative >treatments.
Thats why I feel so bad about attacking drugs. When I do, I come across as some appologist for mental suffering. I don't want to see people in pain, and of course I want people to get better.
Linkadge
Posted by SLS on November 4, 2006, at 6:50:29
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 3, 2006, at 10:00:44
> Antidepressants have not statistically altered the rate of suicide since their introduction.
I guess that depends upon whose statistics you look at.
"Suicide rates rose steadily from 1960 to 1988, when Prozac [fluoxetine], the first SSRI drug, was introduced," he said. "Since then, suicide rates have dropped precipitously, sliding from the eighth to the 11th leading cause of death in the United States."
http://pn.psychiatryonline.org/cgi/content/full/40/7/29
- Scott
Posted by linkadge on November 4, 2006, at 8:13:21
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by SLS on November 4, 2006, at 6:50:29
I think its important to read some of the limitations of that study. In addition, I have a hard time believing that the SSRI's are any more effective in reducing suicide than TCA's or MAOI's, perhaps less lethal.
***Change in the rank**** of suicide as a cause of death is meaningless, as it does not account for changes in the comparitor classes of mortality.
If you look at a graph of the trends in suicide rate over the past century, you will see that the reduction in sucide since the late 80's is very insignificant, compared to what it was prior this apex.
What about other coutries? Suicide has risen significantly in Russia and other countries which use antidepressants. In russia it is the leading cause of death among young males.
It is rising in Irelan, Ausralia, and New Zealand.
No change in the Canadian suicide rate. (every third person is on drugs here)
http://fathersforlife.org/health/cansuic.htm
And you're right it depends on who's data you analyze. This data shows no such reduction, (source, national centre for injury prevention and control)
See first graph:
http://fathersforlife.org/suicides/US_suicide_deaths.htm#Suiciderates
Linkadge
Posted by Lindenblüte on November 4, 2006, at 9:58:35
In reply to Re: SEROQUEL...monotherapy for Depression?/Li, posted by linkadge on November 4, 2006, at 8:13:21
So, stargazer, how's the seroquel treatment working?
Mine is working okay. I'm almost thinking like I used to back in the good old days!
I really appreciate not being distracted by those bad thoughts of self-hatred and anxiety.
-Li
I'm off to take a walk in the sunshine. I guess monotherapy is not my style. I like psychotherapy, and sunshine therapy, and happy eating therapy, and socializing therapy.
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