![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 38. Go back in thread:
Posted by polarbear206 on January 31, 2007, at 8:49:43
In reply to Do you have to get a lot worse before better?, posted by blueberry1 on January 30, 2007, at 16:54:45
> I swear anything norepinephrine is bad for me. Same pattern always happens. Initial rapid mood boost. Fades away. Turns into really unbearably severe depression at about day 4, MUCH worse than where I started. And I thought I started out pretty bad. With anything noradrenergic I end up saying stuff like, "more depressed than I've been in a very long time".
>
> Why is that? I'm going to call my doctor. But I know what she'll say...I'm not yet on a therapeutic dose and you need to be on one for at least a month. But there is no way in hell I can survive this.
>
> This time the pattern repeated with cymbalta. I am only at a ridiculous 8mg. Today was the absolute worst day in longer than I can remember. I was NOT this bad before I started.
>
> Before my doctor chose cymbalta I told her I do respond to ssris. At least they get rid of the depression mostly. But I am left very blah with no interest or motivation in life. I told her let's get me to that point of safety and then work on the blah symptoms after that. She said cymbalta would do it all. She gave me samples. I wonder what kind of under-the-table kickback they get for giving out samples?
>
> Looking back, nothing I ever tried worked without 5mg zyprexa along with it. Damn. I hate to think about that. I guess I shouldn't argue with results though.
>
> Anyway, is it normal to go from very bad to reallly really really bad? Is it normal to go through that stage before you start feeling better? Is that the stage where people commit suicide shortly after starting an antidepressant or changing a dose? I don't recall ever going through that with paxil or prozac or zoloft or lexapro. Only dl-phenylalanine, adderall, tyrosine, milnacipran, cymbalta, and I'm sure I forgot a few.
>
> What do you think? What should I do?
Blueberry,As you stated above that you had an initial rapid mood boost that faded. Believe me that this type of response is very indicative of an underlying bipolar spectrum disorder. I told you about how I ended up in the psyche ward and diagnosed with severe PPD. Well, they initially started me on imipramine and my response was a rapid mood boost within the first 2 days. My pdoc couldn't believe how fast I responded. It ended up to be short-lived. Trials of various antidepressants did the same thing, only to plunge me into deeper depressions. It wasn't until after I was on a mood stabilizer that my life was normal again. I know that you have tried some MS and zyprexa seemed to work for you. I had the same problem on the SSRI's as far as apathy goes. This was not me at all. Have you tried a low dose of lithium with an AD? The reason I ask is that when I go back to my p-doc appt, I'm goning to ask him to put me on a low of Lithium dose with the lamictal and lower the effexor. The reason for this is that Effexor works great for me, but if I can lower it, It would relieve some of the sexual side effects I have encountered. I have been researching the combo of low dose lithium in conjunction with Lamictal and it appears to be very successful.
Posted by ronaldo on January 31, 2007, at 10:46:24
In reply to Do you have to get a lot worse before better?, posted by blueberry1 on January 30, 2007, at 16:54:45
> What do you think? What should I do?
Hi blueberry, I don't know what you should do. The only suggestion that comes to mind is try taking a holiday off meds altogether, if that is at all possible. Would that be a comfortable/feasible sort of thing for you to do?
Your brain has been subjected to all sorts of medications and maybe it just doesn't want to know anymore. Maybe your brain has developed an allergy to medication full stop. I reckon you have taken more meds than most people on this board.
I reckon you might do yourself some good if you could stay off all meds for a month say. I don't know if that is possible for you to do. Maybe this is the worst advice you can get. I don't know. I just think the brain is an organ that needs time to unscramble itself, especially if it has been subjected to some heavy-duty medication. But thats not the case with you. You are super sensitive to meds. Maybe more reason you should give your brain a rest, if possible.
Perhaps you can try a gentle taper off your meds, in the order you deem advisable. I reckon you are on five or six right now. Maybe some you should stay on. There comes a point in psychiatric medicine when you've tried the lot and then the only way forwards is backwards - less meds rather than more meds. That's my two cents worth - made it go rather a long way didn't I?
ronaldo
Posted by Simcha on January 31, 2007, at 13:09:32
In reply to Re: Do you have to get a lot worse before better? » notfred, posted by blueberry1 on January 30, 2007, at 19:06:34
Blueberry1,
> Yeah, but when you get a lot WORSE? I mean A LOT? I know what side effects feel like and how they go away. This is like drug induced depression more than a side effect.
OK, my experience on Cymbalta has been mostly positive. I can recall the first few days.
I was speedy, I sweat more, I wasn't at all hungry. I felt kind of high. This did not last. I came down after the first week and started to feel more tired, and my appetite returneds somewhat.
Now I'm at at somewhere around six weeks. I have energy. My mood is much improved. My fibromyalgia pain is mostly gone. I might ask the doc to increase my 60mg dose to 90mg because of residual pain.
I feel more like myself and not buzzed. My appetite is normal (I think). I think the celexa made me crave food especially carbs. Now I eat only when hungry and I get full faster (I think after eating a normal sized portion). Cymbalta has really done well for me. Again, it took six weeks to get here.
Also I'm on 300mg of WellburtinXL and up to 1,500mg Neurontin per day. That probably has an effect on everything too.
So, if you feel so terrible that you cannot possibly stand it and it majorly interferes with your life, then run, don't walk, (or make a phone call) to the psychiatrist to talk about it. This is the kind of feedback that psychiatrists usually want from their patients when they start a med. It gives them valuable information and, really, only the psychiatrist should make the final determination on whether or not you should continue or discontinue any med.
With most of our meds it is dangerous to stop abruptly without supervision. You could feel much worse if you stop taking a med when you really should ride it out. Personally, I don't make those decisions without seeking medical advise. I say this from experience. Yes, I can affect my psychiatrist's decisions by giving him my own input, and ultimately he's the one that knows the medication best. I know my body best so my job is to inform him about what's going on in my body when taking a med.
Basically, what I'm saying is that it would be best too call/see your psychiatrist if you are feeling so bad. IMHO
Simcha
Posted by blueberry1 on January 31, 2007, at 15:13:21
In reply to Do you have to get a lot worse before better?, posted by blueberry1 on January 30, 2007, at 16:54:45
Called the doc. Said the headaches needed a lot of advil. Being at work is like being car sick with nausea. Told her my depression is worse than before I started. Told her cymbalta feels like poison to me.
She said to lower the dose and go for another week. Seems pointless. I'm only on 8mg. She said maybe cymbalta is hitting all the right receptors but that since I am so screwed up it is going to feel miserable while things get rearranged. She also said to change my mindset and think of cymbalta as the magic one instead of poison. Yeah right. Look, a med works or it doesn't, regardless of your attitude about it.
She seems to ignore me when I say anything norepinephrine makes me feel like crap. She seemed to ignore that I am feeling a lot worse.
Disappointed and hopeless at this point.
Posted by Quintal on January 31, 2007, at 17:21:36
In reply to Re: Do you have to get a lot worse before better?, posted by blueberry1 on January 31, 2007, at 15:13:21
Have you thought about trying the normal starting dose of Cymbalta? I know that might seem counterintuitive but it's possible you need more to get the full antidepressant effect. I had that problem with Parnate where I became much more depressed until I raised the dose. It's like you get an 'awakening' which feels awful initially because you're used to being half dead. From then on you need to keep taking the AD and increase the dose to the therapeutic level if you're not already at it. What do you think?
Q
Posted by Quintal on January 31, 2007, at 18:16:43
In reply to Re: Do you have to get a lot worse before better?, posted by blueberry1 on January 31, 2007, at 15:13:21
Thought you might be interested to read this:
__________________________________________________Eli Lilly and Company had the formula for duloxetine hydrochloride patented in 1991. They began research on human subjects at 20mg by 1997. Initial trials conducted in depressed patients using regimens of 20 mg/day or less did not convincingly demonstrate its efficacy as an antidepressant.
http://en.wikipedia.org/wiki/Duloxetine
__________________________________________________Q
Posted by ralphrost on January 31, 2007, at 21:00:02
In reply to Re: Do you have to get a lot worse before better?, posted by blueberry1 on January 31, 2007, at 15:13:21
Hello blueberry,
although I understand the way you feel when you say "Look, a med works or it doesn't, regardless of your attitude about it", I believe that your confidence on your medication/treatment is also important. Remember that our brain is a complex system with multiple feedback mechanisms that affect each other. We can certainly fight something "strange" that got into our system.
The antidepressants are thought as substances that only start the healing process. Your mind is powerful, so you can really help on this process.
I read in a book (Against Depression, Peter Kramer) that some people have spontaneous full remission while on drugs for as long as months. Just like: you're listening to music and suddenly you notice you're really enjoying it, like you used to do in the past. You noticed a big difference without expecting it.
This helps me when I think about prematurely switching a medication that is promising. Sometimes I prefer to think the drug is slowly healing me and creating an opportunity for my body to take control of my health back again. And I also try to think of how long it took for me to get sick as I currently am. The recover should take a long time too, despite our big anxiety to feel fine tomorrow.
Sorry that I don't have an answer to your question, just some thoughts. Hope they help you somehow.
Best wishes
Ralph
> Called the doc. Said the headaches needed a lot of advil. Being at work is like being car sick with nausea. Told her my depression is worse than before I started. Told her cymbalta feels like poison to me.
>
> She said to lower the dose and go for another week. Seems pointless. I'm only on 8mg. She said maybe cymbalta is hitting all the right receptors but that since I am so screwed up it is going to feel miserable while things get rearranged. She also said to change my mindset and think of cymbalta as the magic one instead of poison. Yeah right. Look, a med works or it doesn't, regardless of your attitude about it.
>
> She seems to ignore me when I say anything norepinephrine makes me feel like crap. She seemed to ignore that I am feeling a lot worse.
>
> Disappointed and hopeless at this point.
Posted by laima on February 1, 2007, at 0:12:38
In reply to Re: Do you have to get a lot worse... - blueberry, posted by ralphrost on January 31, 2007, at 21:00:02
I feel like I am not on the same page as most people here? I am understanding Blueberry saying that cymbalta is making her feel markedly WORSE, not same, not dissapointed that it's not more effective, not impatient that it's not working fast enough or not well enough, or even not at all, but a "PLUNGE". Ie, a paradoxical effect. That doesn't sound good at all. I recall, she had a somewhat paradoxical effect with adderall, too. A lot of people report mood boost with adderall- witness remedyfind- Blueberry got a severe drop. Do I recall Blueberry, that a benzo, xanax was it, made you feel socially livlier? Or I might have that last example mixed up with someone else.
Posted by laima on February 1, 2007, at 0:23:31
In reply to Re: Do you have to get a lot worse... - blueberry, posted by laima on February 1, 2007, at 0:12:38
I thought I'd add, I get paradoxical effects to some meds myself. Doctor doesn't dismiss the phenomena. Chamomile tea makes me jittery-the more I drank-the worse it got, before I figured it out. Note there have been reports of people getting sleepy on ritalin and amphetamines on babble before. People with ADD calm down on amphetamines. My brother and I share paradoxical effects to some of the same meds, like some sleep meds, which make us feel "wired". Independently- we compared notes years later. Sounds like a genetic component. My own trial of cymbalta was hell. I felt lousy, and within a day or so felt near suicidal. I could hardly function whatsoever, even through a cousin's wedding. I almost didn't go, and had to leave early. Groggy beyond belief, weepy, nauseaous, achey...and sense of life as living hell. I stuck it out in good faith for another day or so before calling doctor, who, alarmed, pulled me off immediately. My mood restabilized to where it was before cymbalta. It was the wrong med for me. Note many antidepressents carry warnings to watch for worsening moods. It is possible. Antidepressents don't necessarily lift one's mood- don't necessarily do nothing, either.
Posted by laima on February 1, 2007, at 0:30:29
In reply to Re: Do you have to get a lot worse before better? » blueberry1, posted by ronaldo on January 31, 2007, at 10:46:24
Ronaldo, I like your thinking. It sounds like a good idea- find where the baseline is. Maybe try to refortify, with fish oil, maultivatims, especially Bs, antioxidants.I was once on way, way too many meds- like 10! That doctor's philosophy seemed to be, "Not working? Let's add another one- and another...well, it's doing SOMETHING...let's try adding a couple more...this one's supposed to be good". Etc. That didn't last long, and my goodness, I was never such a mess before or since. The chaos of that doctor's plan landed me in the hospital for a few days- where they detoxed me off everything, found me a new doctor, and we started over, slow and simple. I was amazed at how much stabler and saner I felt.
> What do you think? What should I do?
>
> Hi blueberry, I don't know what you should do. The only suggestion that comes to mind is try taking a holiday off meds altogether, if that is at all possible. Would that be a comfortable/feasible sort of thing for you to do?
>
> Your brain has been subjected to all sorts of medications and maybe it just doesn't want to know anymore. Maybe your brain has developed an allergy to medication full stop. I reckon you have taken more meds than most people on this board.
>
> I reckon you might do yourself some good if you could stay off all meds for a month say. I don't know if that is possible for you to do. Maybe this is the worst advice you can get. I don't know. I just think the brain is an organ that needs time to unscramble itself, especially if it has been subjected to some heavy-duty medication. But thats not the case with you. You are super sensitive to meds. Maybe more reason you should give your brain a rest, if possible.
>
> Perhaps you can try a gentle taper off your meds, in the order you deem advisable. I reckon you are on five or six right now. Maybe some you should stay on. There comes a point in psychiatric medicine when you've tried the lot and then the only way forwards is backwards - less meds rather than more meds. That's my two cents worth - made it go rather a long way didn't I?
>
> ronaldo
>
>
Posted by stargazer on February 1, 2007, at 1:21:14
In reply to Re: Do you have to get a lot worse before better? » ronaldo, posted by laima on February 1, 2007, at 0:30:29
I don't believe in the getting worse before getting better logic. It just does not make sense ever to push through something that inherently feels so wrong.
I have had effects like that before, only could take 2 dose of Remeron, period. Insisted to my pdoc it was making me feel worse. And with Zoloft, I developed suicidal ideation and despite my pdoc insisting that I give it some more time, I told him I would kill myself if I stayed on it. He listened to me. That was before the warnings about AD's inducing suicidal thinking was ever mentioned. The pdocs really believed if you were suicidal, it was your depression getting worse and all the more reason to increase the dose of the med. Once Zoloft was stopped, the SI stopped.
So only you can say when enough is enough and in my opinion more negative symptoms added to an already severe depression is not the answer, it may be a hyperensitivity to the drug ,which never is considered.
All you should do is give it your best attempt to try the drugs and if they make you so miserable, then you consider the med wrong for you and cross it off and put it on the "BAD" list to not try again. It doesn't mean not to ever try it again, but not in the near future.
My trial with Cymbalta lasted 2 weeks max, one week at 20 mg felt so-so, second week at 40 mg, got more depressed, less motivated, got into bed and only got up for food,, mostly fluids and basic personal needs. That was enough to tell me it was not working for me. There are some critical periods where if a med does not improve my condition enough to warrant taking it, I have to try something that will help and if it means taking seroquel or something to alleviate my distress as a short term solution, than so be it.
My experience with meds has shown me that either a med works quickly, like the MAO's did or they work more slowly, but with minimal side effects, which can be managed with a reduction in dosage or taking Tylenol. I have severe SE's too and when my body says a drug is wrong, it is usually for a good reason.
Good luck Blueberry, I just don't think Cymbalta is not the one for you, but you have to trust your instincts on that, no one else can tell you when to stop.
Stargazer
Posted by Quintal on February 1, 2007, at 3:49:58
In reply to Re: Do you have to get a lot worse... - blueberry, posted by laima on February 1, 2007, at 0:12:38
SSRI/SNRI antidepressants are not instant mood brighteners like opiates/benzodiazepines. Most of the people posting here should be aware of that by now, so it surprises me to see people rejecting them because their depression and anxiety gets worse initially. Paradoxical worsening of depression and anxiety is a classic, well documented side effect of this type of medication and doctors sometimes prescribe a benzo to take alongside it during the first few weeks for this reason. It simply does not mean that the drug will never work and if people repeatedly give up trials after three days it seems unlikely they will ever find an acceptable treatment in this class of antidepressant. It's entirely possible that dramatic initial worsening may lead to dramatic improvement after the typical 2-4 week time 'lag' between starting an antidepressant and the onset of the antidepressant effect. It can then take a further month or two to feel the full benefit.
Has blueberry tried using Xanax to help him through this period?
Q
Posted by ralphrost on February 1, 2007, at 8:01:01
In reply to Re: Do you have to get a lot worse... - blueberry, posted by laima on February 1, 2007, at 0:12:38
Hello laima,
I understand what blueberry is saying, because I also use to have initial mood boosts and then crashes, as soon as I start ADs. It's AWFUL, and I have many times strong suicidal tendencies in the beginning. I'm also sick of that effect and it's happening (again) right now with me, on Tianeptine.
As posted above by Quintal, I also believe he should try to add something (benzo is the easyest and fastest) to make the initial period "livable", instead of giving up soon on a drug.
My post was only about trying to encourage him to be positive about the drug, and about how long it takes for a cure (not an improvement) to happen.
Ralph
>
> I feel like I am not on the same page as most people here? I am understanding Blueberry saying that cymbalta is making her feel markedly WORSE, not same, not dissapointed that it's not more effective, not impatient that it's not working fast enough or not well enough, or even not at all, but a "PLUNGE". Ie, a paradoxical effect. That doesn't sound good at all. I recall, she had a somewhat paradoxical effect with adderall, too. A lot of people report mood boost with adderall- witness remedyfind- Blueberry got a severe drop. Do I recall Blueberry, that a benzo, xanax was it, made you feel socially livlier? Or I might have that last example mixed up with someone else.
Posted by laima on February 1, 2007, at 9:26:15
In reply to Re: Do you have to get a lot worse... - blueberry, posted by ralphrost on February 1, 2007, at 8:01:01
Yes, I agree, you have valid points, especially about the importance of maintaining faith in one's med, and it wasn't my intention to take an "off" tone. I guess the nuances of this situation are tricky to talk about-at least for me. I'm just concerned that Blueberry's mood could absolutely tank to a suicidal level over this waiting period experiment. There is no guarentee that it will end up working, and meanwhile, she's really suffering. I'm confused and concerned why people feel so certain about the cymbalta. Why must the med be cymbalta- I don't understand. I've also not sure I buy the must-feel-worse-than-before-for-awhile-and-you-might-improve-later philosophy, but not worth me arguing it here. (We'd go in circles, and I sure don't want to instigate arguements with anyone.) How exactly can it turn around 180 in a couple weeks to improve mood? Can anyone explain? I've been concerned too, that people are reading, understanding her report as something along the mood of, "Well it's been a couple days- not working yet! It sucks!" But perhaps, from how you and Quintal explain further, I am wrong in this assumption.
I've tried numerous antidepressents which didn't work, some that did work at varying degrees- only a very, very few caused such a severe drop, cymbalta was one, just by coincidence. I'm concerned that this pharmaceutically-induced worsened depression period is very dangerous-so I feel quite alarmed by that and helpless to help. My own experience with it led to fantasizing about all kinds of accidents, risky behavior like walking in front of speedy cars- scary stuff. How can anyone be sure that this is not a paradoxical effect? Why cymbalta? Is there not another medication that could at least stay neutral and ineffective during its pre-effective period? I just feel really worried. Maybe now I'll leave it at that, as I don't wish to risk any offense for anyone over my divergent viewpoint, or risk making the situation even more unpleasant for anyone in any way. I'm starting to feel a tad cloddish. I have only best wishes for everyone's safety and peace of mind-but I do feel awfully worried about this situation.
> Hello laima,
>
> I understand what blueberry is saying, because I also use to have initial mood boosts and then crashes, as soon as I start ADs. It's AWFUL, and I have many times strong suicidal tendencies in the beginning. I'm also sick of that effect and it's happening (again) right now with me, on Tianeptine.
>
> As posted above by Quintal, I also believe he should try to add something (benzo is the easyest and fastest) to make the initial period "livable", instead of giving up soon on a drug.
>
> My post was only about trying to encourage him to be positive about the drug, and about how long it takes for a cure (not an improvement) to happen.
>
> Ralph
>
> >
> > I feel like I am not on the same page as most people here? I am understanding Blueberry saying that cymbalta is making her feel markedly WORSE, not same, not dissapointed that it's not more effective, not impatient that it's not working fast enough or not well enough, or even not at all, but a "PLUNGE". Ie, a paradoxical effect. That doesn't sound good at all. I recall, she had a somewhat paradoxical effect with adderall, too. A lot of people report mood boost with adderall- witness remedyfind- Blueberry got a severe drop. Do I recall Blueberry, that a benzo, xanax was it, made you feel socially livlier? Or I might have that last example mixed up with someone else.
>
>
Posted by ralphrost on February 1, 2007, at 10:44:30
In reply to Re: Do you have to get a lot worse... - blueberry » ralphrost, posted by laima on February 1, 2007, at 9:26:15
<<How exactly can it turn around 180 in a couple weeks to improve mood? Can anyone explain? I've been concerned too, that people are reading, understanding her report as something along the mood of, "Well it's been a couple days- not working yet! It sucks!">>
Once I read a research report saying that depressed people display a higher sensitivity to stimulating drugs like amphetamines. They tested both normal and depressed subjects and noticed that depressed people responded more vigorously to stimulants. Maybe that's why we have such bad reactions. SNRIs and others use to be stimulating drugs.
It does take time for neurogenesis and structural changes to happen, so such bad reactions hit us in a bad time.
If our system will start a healing process with a drug is a big mistery though, but we only discovery this giving enough time for both the drug and our body.
How are you doing blueberry? Best luck with your treatment (you too laima). You'll be fine :)
Posted by Quintal on February 1, 2007, at 10:50:45
In reply to Re: Do you have to get a lot worse... - blueberry » ralphrost, posted by laima on February 1, 2007, at 9:26:15
Laima, I for one don't believe that antidepressants *must* exacerbate the symptoms of depression before they get better, I'm just pointing out that this is a very common (and unfortunate) side effect in the beginning of treatment with SSRIS/SNRIs, that people may have to endure if possible before they begin to feel the positive effects. Like going through the wilderness to get to the promised land.
>Why cymbalta? Is there not another medication that could at least stay neutral and ineffective during its pre-effective period?
The problem is that blueberry has tried umpteen different meds from various classes in the last few months and quit after a few days for the same reason, so why not Cymbalta? It seems likely that blueberry will have this problem with other meds in the same class, so from my perspective switching to yet another SSRI/SNRI would likely just waste time and more money giving the same result. That's also why I suggested he try Parnate plus a benzo since he's never taken this class of med before and it tends to be very effective in depression refractory to other ADs. I'm also wondering if a mood stabilizer like lithium in addition to that combo might be worth trying as an augmenter?
>I'm starting to feel a tad cloddish. I have only best wishes for everyone's safety and peace of mind-but I do feel awfully worried about this situation.
I don't think you're at all cloddish. You're clearly concerned for blueberry's safety, as we all are, we just have different views on how best to manage the initial side effects of antidepressants. Ultimately blueberry knows his circumstances best and I trust he has enough experience dealing with this illness to judge what's best for himself.
Q
Posted by polarbear206 on February 1, 2007, at 13:22:50
In reply to Re: Do you have to get a lot worse... - blueberry » laima, posted by Quintal on February 1, 2007, at 10:50:45
> Laima, I for one don't believe that antidepressants *must* exacerbate the symptoms of depression before they get better, I'm just pointing out that this is a very common (and unfortunate) side effect in the beginning of treatment with SSRIS/SNRIs, that people may have to endure if possible before they begin to feel the positive effects. Like going through the wilderness to get to the promised land.
>
> >Why cymbalta? Is there not another medication that could at least stay neutral and ineffective during its pre-effective period?
>
> The problem is that blueberry has tried umpteen different meds from various classes in the last few months and quit after a few days for the same reason, so why not Cymbalta? It seems likely that blueberry will have this problem with other meds in the same class, so from my perspective switching to yet another SSRI/SNRI would likely just waste time and more money giving the same result. That's also why I suggested he try Parnate plus a benzo since he's never taken this class of med before and it tends to be very effective in depression refractory to other ADs. I'm also wondering if a mood stabilizer like lithium in addition to that combo might be worth trying as an augmenter?
>
> >I'm starting to feel a tad cloddish. I have only best wishes for everyone's safety and peace of mind-but I do feel awfully worried about this situation.
>
> I don't think you're at all cloddish. You're clearly concerned for blueberry's safety, as we all are, we just have different views on how best to manage the initial side effects of antidepressants. Ultimately blueberry knows his circumstances best and I trust he has enough experience dealing with this illness to judge what's best for himself.
>
> Q
As I said in my previous post above, I really think she should trial a low dose of lithium to augment the cymbalta. I totally agree with Q on this. Blueberry's refractory deprssion is a red flag for trying the use of a mood stabilizer. I am very confident she can beat this!!! Blueberry, when you read this post, please consider sending an e-mail to Dr. Ivan Goldberg. He is a highly respected psychiatrist who deals with refactory deprssion. He can offer you suggestions to work with your Doctor. His practice is in NYC. I would go to him in a heartbeat if I were in your shoes. I don't know where you live in regards to NYC. I only live 3 hours away. I have corresponded him in the past.Http://www.psycom.net/ikg 8.html
Posted by ronaldo on February 1, 2007, at 13:39:54
In reply to Do you have to get a lot worse before better?, posted by blueberry1 on January 30, 2007, at 16:54:45
Hello blueberry,
How are you feeling now - 2 days later?
Have you taken any decisions re your meds or re your pdoc?
I sure hope something has improved for you.
ronaldo
Posted by ronaldo on February 1, 2007, at 16:07:32
In reply to Re: Do you have to get a lot worse before better?, posted by blueberry1 on January 31, 2007, at 15:13:21
Have you made a decision re your meds?
Any joy with your pdoc?
I sure hope things start to improve for you
ronaldo
Posted by blueberry1 on February 1, 2007, at 16:42:35
In reply to Do you have to get a lot worse before better?, posted by blueberry1 on January 30, 2007, at 16:54:45
Still feeling like crap. Extremely dysphoric, poisoned, more depressed than before starting cymbalta.
Zoloft never did this to me. I just got side effects, felt the same, and in just a few days was already feeling slight hints of getting better. Prozac never did this to me. I started feeling slightly better in 2 days and it lasted years before turning against me.
Paxil was hard to get started with all kinds of side effects, but it did not make my depression worse at the beginning. The only ssri that made my depression worse was lexapro.I know what side effects are. This is not side effects. I agree with the posters here that said this is not normal. In my experience, it is not normal. With any drugs that ever helped me, this did not happen. On the contrary, they showed tolerable side effects and quick hints of goodness that continued to improve slowly with time.
Posted by Quintal on February 1, 2007, at 17:50:59
In reply to Re: Do you have to get a lot worse before better?, posted by blueberry1 on February 1, 2007, at 16:42:35
Blueberry, I'm sorry if it seems I've been unsupportive by advising you to persevere with Cymbalta, that was not my intention. I was doing nothing more than giving my personal opinion to the question posed on the title of this thread.
>With any drugs that ever helped me, this did not happen. On the contrary, they showed tolerable side effects and quick hints of goodness that continued to improve slowly with time.
This doesn't mean the only drugs that could ever help you are the ones that make you feel good initially, all you're seeing there is the result of your refusal to persevere with drugs that make your depression worse initially. No drug that exacerbates your depression in the beginning could ever be a success for you because you quit taking them before waiting the recommended time of 4-6 weeks. It seems the only drugs that have helped long-term were the ones that made you feel good initially, and it seems to me that is because the ones that worsened your depression were aborted early in the trial so never got the chance to help you long-term. Therefore you can't fairly say these drugs would not have helped if you had taken them for the same length of time as you took Zoloft, Prozac and Paxil.
I do not mean to be argumentative or diminish your suffering in any way. I respect your point of view. However, I still maintain that it's 'normal' and common for symptoms of the original condition to deteriorate early in SSRI/SNRI therapy. This is written in most patient information leaflets and doctors usually tell patients to persevere if and when this happens because the end result is worth it. My GP did not believe me when I told her I felt a positive (hypomanic) response to Cipralex after three days - she claimed this doesn't happen. It was my psychiatric nurse that informed me that a subset of patients do sometimes respond in this way and they are usually the ones who have bipolar II. Seriously, have you considered taking Zoloft or Prozac with a mood stabilizer such as lithium or Lamictal? Perhaps Zyprexa was acting as a mood stabilizer all along?
Q
Posted by blueberry1 on February 2, 2007, at 4:49:02
In reply to Re: Do you have to get a lot worse before better? » blueberry1, posted by Quintal on February 1, 2007, at 17:50:59
Thanks for the input. I appreciate it. I have always believed that the closer a drug is to targeting the real problem, the quicker it will work and with less side effects. The farther it is away from the real problem, the longer it takes and more side effects, due to downstream adjustments rather than hitting a bullseye. There are clinical studies that show that. Two of them at pubmed. I just dond't have what it takes right now to go find them.
With paxil and another drug, can't remember what it was, they showed that patients who showed improvement in the first 2 weeks was highly predictive of good response at 6 weeks. About 80% of the responded. If there was no improvement at 2 weeks, only 20% of those folks went on to respond at 6 weeks. No guarantee either way, the odds are significantly in favor of those with early response. Responding with longer trials does exist, and it is of course common philosophy, but the odds are greatly diminished if there is not a hint of improvement in 2 weeks.
You make a good point about bipolar. As I think back, depakote had me feeling significantly better in 24 hours after being on lousy lexapro for a month. Then started zoloft. Worked fast. Was not depressed, but instead just very blah and uninterested in life. When stopped the depakote because I couldn't feel it doing anything, I crashed hard into the emergency room. So zoloft alone was not doing the trick. There was some synergy, perhaps bipolar related.Also saw in clinical studies that depakote+zyprexa (I was still on zyprexa) cause a synergistic increase in dopamine.
Lamictal gave immediate profound antidepressant effect even at just 6mg. Felt very dopaminergic to me. By day 4 I was engulfed in anxiety nervousness beyond belief and depression was very rapidly getting intensely worse. 3.4% of lamictal trial users experience suicidal ideation compared to .3% prozac+zyprexa. I was pretty darn close to that.
Lithium tried it. Again, immediate antidepressant response at just 100mg. Intense confusion, cognitive dulling, rapid heartbeat, and severe hypotension did not allow me to continue. Tried the natural lithium orotate. It was tolerable. Had a slight hint of improvement immediately. AFter that it just seemed to flatten my moods to where I was depressed all the time instead of being depressed all day with some improvement in the evening, which was the pattern I was accustomed to. With lithium orotate the evening improvement was gone and I was just steadily depressed 24/7.
The whole psychiatry thing is so flawed and screwed up. But I have tried going without meds for a month and things were just as screwed or worse. A rock and a hard place.
Posted by notfred on February 2, 2007, at 8:46:51
In reply to Re: Do you have to get a lot worse before better? » Quintal, posted by blueberry1 on February 2, 2007, at 4:49:02
> Thanks for the input. I appreciate it. I have always believed that the closer a drug is to targeting the real problem, the quicker it will work and with less side effects. The farther it is away from the real problem, the longer it takes and more side effects, due to downstream adjustments rather than hitting a bullseye. There are clinical studies that show that. Two of them at pubmed. I just dond't have what it takes right now to go find them.
>
For me this is not true. All AD's take ~6 weeks to begin to work. I have been mostly in remission for 2 decades so the AD's do work quite well once they start working. All AD suck, with side effects, for the first few week, for me.I would not hold up studies as being the end all and be all, given we still do not know why AD's work. Nothing is proven, all is theory. The same goes for a biochemical model for depression or any MI for that matter.
Posted by elanor roosevelt on February 2, 2007, at 17:17:29
In reply to Re: Do you have to get a lot worse before better?, posted by blueberry1 on February 1, 2007, at 16:42:35
> I know what side effects are. This is not side effects. I agree with the posters here that said this is not normal. In my experience, it is not normal.Blueberry
this is your life
being asked to "stay" with a med that is making you feel very bad is just wrong
"oh, give it more time" they say
once after a pdoc said that to me i explained that i was having dreams about killing cute little baby animals
she changed her mind
sorry -- back to you
it does not sound like you need a drug wash-out
it sounds like you need some help now
call your pdoc and tell him/her that asking you to stay like this is cruel and that you need help now
good luck
Posted by rina on February 3, 2007, at 19:09:13
In reply to Do you have to get a lot worse before better?, posted by blueberry1 on January 30, 2007, at 16:54:45
> I swear anything norepinephrine is bad for me. Same pattern always happens. Initial rapid mood boost. Fades away. Turns into really unbearably severe depression at about day 4, MUCH worse than where I started. And I thought I started out pretty bad. With anything noradrenergic I end up saying stuff like, "more depressed than I've been in a very long time".
>
> Why is that? I'm going to call my doctor. But I know what she'll say...I'm not yet on a therapeutic dose and you need to be on one for at least a month. But there is no way in hell I can survive this.
>
> This time the pattern repeated with cymbalta. I am only at a ridiculous 8mg. Today was the absolute worst day in longer than I can remember. I was NOT this bad before I started.
>
> Before my doctor chose cymbalta I told her I do respond to ssris. At least they get rid of the depression mostly. But I am left very blah with no interest or motivation in life. I told her let's get me to that point of safety and then work on the blah symptoms after that. She said cymbalta would do it all. She gave me samples. I wonder what kind of under-the-table kickback they get for giving out samples?
>
> Looking back, nothing I ever tried worked without 5mg zyprexa along with it. Damn. I hate to think about that. I guess I shouldn't argue with results though.
>
> Anyway, is it normal to go from very bad to reallly really really bad? Is it normal to go through that stage before you start feeling better? Is that the stage where people commit suicide shortly after starting an antidepressant or changing a dose? I don't recall ever going through that with paxil or prozac or zoloft or lexapro. Only dl-phenylalanine, adderall, tyrosine, milnacipran, cymbalta, and I'm sure I forgot a few.
>
> What do you think? What should I do?Sometimes I really feel as if the side effects of the medicines is worse than the cure.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.