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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 39. This is the beginning of the thread.
Posted by girlnterrupted78 on September 16, 2007, at 23:35:15
So my current pdoc wasn't joking when he said that after Nardil, that was *it*.
Yesterday's session, we discussed my progress (or lack thereof) with Nardil. He took out his notes and noted that he raised my Nardil dose more than 2 months ago.
I've been on Nardil for almost 4 months, and 2.5 of those months I was already on the higher dose without Nardil kicking in, without any actual results.
So he said that was it. The next thing he could do for me was direct me to have ECT.
I told him that I didn't think that was the ONLY option (I can't afford ECT right now, and I don't think I want to do that yet anyway..) I mean, isn't ECT dangerous? Isn't ECT temporary? Don't you need several ECT sessions? Doesn't ECT poop out, like EVERY OTHER AD OUT THERE? What do I need ECT for, then? To get a few days relief, forget things, and pay a fortune? No thanks.
I told him there's some drugs I haven't tried yet. I mentioned EMSAM. He said "Emsam is just like Nardil--another MAOI. In fact, Nardil is better. I wouldn't recommend it over Nardil."
Then I mentioned that out of all the SSRIs, I never tried Prozac (I tried Celexa, Zoloft, and Paxil.)
He said:
"Well, we could try everything. But I'm not going to do that. IMO, you have tried every group of medications without results. So *I* won't prescribe anything else."So my only option at that point was to get a second opinion. So I asked him if I could transfer to another psychiatrist in the clinic to get another opinion. He said "yes, that's not a problem."
So that's my story with my pdoc. It made me lose faith because I realized there is, in fact, very little hope in any other antidepressant working for me.
I'm starting to realize that antidepressants are just like Adderall. It worked amazing for a period, and for some STRANGE, UNKNOWN REASON, I built tolerance very soon.
I need to figure out what exactly is building tolerance and why, and how do I tackle that chemically? I suspect it's dopamine. But why do I have such a horrible dopamine deficiency, and why NOTHING works? How on earth do you cure something like this? I've done everything. I exercise. I eat right. I eat protein, good carbs, omega 3's, what else has to be done to be normal?
Does anyone know if there are any specific specialists out there who focus on this specific problem?
I doubt pdocs will help me any further. I built tolerance and no matter what I try, I doubt it'll work. I really need to see someone above pdocs (are psychopharmacologists trained on this matter, anyone knows?)
I'm desperate and I need help. I can't continue like this. It's been years of depression, years of wasting my life, years of trying antidepressants, and years of antidepressants not working. Pdocs are not what I need anymore. All they can offer is AD's, and no antidepressant works for me any longer. NONE. After Celexa's poop out, NOTHING has worked AT ALL.
Any help would be greatly appreciated. I've been so depressed over this, that I slept all weekend. Yeah, all day over the weekend. I had lots of homework, but of course, I didn't do any of it, which makes me even more depressed. It seems like I'm walking towards a dark hole from which I'll never be able to walk out.
Posted by stargazer2 on September 17, 2007, at 8:00:56
In reply to Forced to terminate current Pdoc after Nardil fail, posted by girlnterrupted78 on September 16, 2007, at 23:35:15
GI, your story is exactly like mine...many AD's with little relief over 30 years, although I did have relief for brief periods here and there. I don't know how long you have had depression but I have had it for so long now the depression has become more and more difficult to treat,
My pdoc is always the eternal optimist. He says there are always more combinations that I haven't tried yet and he gives me hope to keep trying although I have been where you are at more times than I care to remember.
Nardil alone wasn't totaally effective enough so we started to augment it with a few other meds. I also took an article for my pdoc to see that was written by experts on MAO's that outlined what other meds could be added to Nardil even though they are usually contraindicated. He is very careful but will try other meds that he feel can be safely combined.
I just started on Nortriptyline, an older drug known as a tricyclic and also on Synthroid. Read my response to Treatment resistent here! (post above) since between the Nortriptyline and/or the Synthroid, I have broken through the depression.
Your doctor is obviously not pushing meds to a higher level of combining them and his lack of support for you is is seriously deficient. I too will not have ECT for many reasons, some of which you have mentioned.
I'm not sure what type of advice I can give you other than trying to find a real expert with depression medications. Is there a teaching hospital you can contact near you? You have to find a pdoc that will be comfortable using all meds in various combinations. Your pdoc doesn't sound like he has enough expertise and confidence in his ability to really work with you. He sounds less than supportive of you and acts like all options have been exhausted but I seriously think that is a copout. He just isn't experienced enough to work with you until something does work. Believe me, that can be an exhausting process that many pdocs don't have the time or energy to deal with. I'm very lucky that my pdoc keeps me trying things rather than giving up on me. It's very easy to give up on ourselves that is why our docs have to provide the optimism we are incapable of having when we are really down.
Stargazer
Posted by polarbear206 on September 17, 2007, at 8:30:50
In reply to Forced to terminate current Pdoc after Nardil fail, posted by girlnterrupted78 on September 16, 2007, at 23:35:15
> So my current pdoc wasn't joking when he said that after Nardil, that was *it*.
>
> Yesterday's session, we discussed my progress (or lack thereof) with Nardil. He took out his notes and noted that he raised my Nardil dose more than 2 months ago.
>
> I've been on Nardil for almost 4 months, and 2.5 of those months I was already on the higher dose without Nardil kicking in, without any actual results.
>
> So he said that was it. The next thing he could do for me was direct me to have ECT.
>
> I told him that I didn't think that was the ONLY option (I can't afford ECT right now, and I don't think I want to do that yet anyway..) I mean, isn't ECT dangerous? Isn't ECT temporary? Don't you need several ECT sessions? Doesn't ECT poop out, like EVERY OTHER AD OUT THERE? What do I need ECT for, then? To get a few days relief, forget things, and pay a fortune? No thanks.
>
> I told him there's some drugs I haven't tried yet. I mentioned EMSAM. He said "Emsam is just like Nardil--another MAOI. In fact, Nardil is better. I wouldn't recommend it over Nardil."
>
> Then I mentioned that out of all the SSRIs, I never tried Prozac (I tried Celexa, Zoloft, and Paxil.)
>
> He said:
> "Well, we could try everything. But I'm not going to do that. IMO, you have tried every group of medications without results. So *I* won't prescribe anything else."
>
> So my only option at that point was to get a second opinion. So I asked him if I could transfer to another psychiatrist in the clinic to get another opinion. He said "yes, that's not a problem."
>
> So that's my story with my pdoc. It made me lose faith because I realized there is, in fact, very little hope in any other antidepressant working for me.
>
> I'm starting to realize that antidepressants are just like Adderall. It worked amazing for a period, and for some STRANGE, UNKNOWN REASON, I built tolerance very soon.
>
> I need to figure out what exactly is building tolerance and why, and how do I tackle that chemically? I suspect it's dopamine. But why do I have such a horrible dopamine deficiency, and why NOTHING works? How on earth do you cure something like this? I've done everything. I exercise. I eat right. I eat protein, good carbs, omega 3's, what else has to be done to be normal?
>
> Does anyone know if there are any specific specialists out there who focus on this specific problem?
>
> I doubt pdocs will help me any further. I built tolerance and no matter what I try, I doubt it'll work. I really need to see someone above pdocs (are psychopharmacologists trained on this matter, anyone knows?)
>
> I'm desperate and I need help. I can't continue like this. It's been years of depression, years of wasting my life, years of trying antidepressants, and years of antidepressants not working. Pdocs are not what I need anymore. All they can offer is AD's, and no antidepressant works for me any longer. NONE. After Celexa's poop out, NOTHING has worked AT ALL.
>
> Any help would be greatly appreciated. I've been so depressed over this, that I slept all weekend. Yeah, all day over the weekend. I had lots of homework, but of course, I didn't do any of it, which makes me even more depressed. It seems like I'm walking towards a dark hole from which I'll never be able to walk out.Have you tried a mood stabilizer with an AD? This combo can prevent AD poop out. What is your diagnosis? TRD, Bipolar?
Polarbear
Posted by Emme on September 17, 2007, at 9:12:26
In reply to Forced to terminate current Pdoc after Nardil fail, posted by girlnterrupted78 on September 16, 2007, at 23:35:15
You need a specialist in treatment resistant depression. It doesn't sound like your doctor has done much in the way of polypharmacy.
Have you tried Lamictal?
I have also found Abilify to be an effective antidepressant. I've had a more sustained response on Lamictal + Abilify than I have had on antidepressants. Not perfect, there are still bumps in the road, but they definitely help.My pdoc has had some good results using memantine for depression. I responded very well to it. I couldn't tolerate an effective dose and eventually stopped it, but I am extraordinarily sensitive to side effects. It might be worth a trial for you.
I don't think you've hit the end of the road yet as far as treatment options. Good luck.
emme
Posted by Phillipa on September 17, 2007, at 11:29:19
In reply to Re: Forced to terminate current Pdoc after Nardil » girlnterrupted78, posted by Emme on September 17, 2007, at 9:12:26
Yes good luck didn't know there were special docs who dealth with tx resistant patients. Phillipa
Posted by deniseuk190466 on September 17, 2007, at 15:57:48
In reply to Re: Forced to terminate current Pdoc after Nardil fail, posted by stargazer2 on September 17, 2007, at 8:00:56
Hi,
If ECT's good affects don't last very long, causes memory problems and is usually a last resort then whey do they give it to people at all.
Surely, if a person has exhausted all medicine options then what's going to change after they've had ECT and the good affects have worn off?
I have read of people for whom ECT has worked and where they've been depression free for at least a year afterwards, so it does work for some people (as you probably know) it's just a pity they can't predict who.
Denise
Posted by twinch42085 on September 17, 2007, at 16:41:29
In reply to Forced to terminate current Pdoc after Nardil fail, posted by girlnterrupted78 on September 16, 2007, at 23:35:15
There is hope. It takes time to figure out what medications is right for you. I know you said that you have tried every medication out that except prozac. What is your diagnosis. Are you bipolar. Do you have dythysmia. Maybe you should try a new pdoc. I don't know about ECT. That is a last resort when nothing works. I believe that ECT only prevents things from coming about half the time the therapy is done. I have you tried symbyax (prozac and zyprexa). I think that is the one. It might be an option.
Goodluck : )
twinch
Posted by stargazer2 on September 17, 2007, at 17:21:22
In reply to To Stargazer 2 - Another question., posted by deniseuk190466 on September 17, 2007, at 15:57:48
My opinion is that it can work to get you out of a serious depression but I truly believe medicine has a better chance of working for the long term.
I used to work in ECT and I saw many people who did not have an experienced doctor to work with them to get them out of a serious depression. I was once thinking that ECT might work but a medication was successful in getting me out out of place I thought only ECT might be able to. Now I can use that medication when things get as desperate as they were at that time.
I think ECT can disrupt your brain chemistry both chemically and physically but so many long term side effects are too scary for me to ever want to try it myself. Although I know why some try it, I just don't think it works any better for depression long term. That is my opinion based on my experiences with medication and my doctor's understanding of my determination to never have ECT.
Seroquel was the medication that got me out of a real bad place, not that I had success with it for long term treatment of my depression.
So for now I'll stick with all kinds of med combos becasue I think if a true "expert" is handling your medications you have at least as good a chance as ECT or even better in my opinion.
SG
Posted by olysi79 on September 17, 2007, at 23:47:13
In reply to Re: Forced to terminate current Pdoc after Nardil fail » girlnterrupted78, posted by polarbear206 on September 17, 2007, at 8:30:50
I am sorry about this pain you are experiencing. hopelessness is a very painful thing.
I am going to offer some suggestions. I am not familiar with your situation, so these are merely suggestions.
1) Consider ECT if it truly is a last resort (read all of my other ideas first). From my understanding, you don't just "get ECT" and then that's it... you get it periodically for a period of time, alongside medications... I may be wrong though.
2) It may be time to pop into AP's (i.e Risperdal, Geodon, etc...)
3) Stimulating TCA medications (it sounds like fatigue and lack of motivation is a problem)
4) Wellbutrin with another medications
5) Lithium with other medications
6) Anti convulsants with other medications
You may need to build a bridge of different combos that are constantly tweaked and worked with. try a variety of combos! Try different meds together at different doses with your PDOC. You shouldn't care at this point if you have to take a dozen medications... you need to find combos that work. Finally, don't diagnose yourself, you don't *know* that you need dopamine. Write down all symptoms, how you feel, when, and let your doc and therapist know.
Next, time to check the hormones... go to an endo and have all of your hormones tested, thyroid, cortisol, all of it. Also, it's time for a new P-Doc... I'd recommend a psychopharmacologist or someone whom specializes in more unique cases... someone whom has advance training beyond psychiatry, as I recently learned on the board, these types might be a good fit for some. Check the medical schools in your area for experts.
Finally, therapy... once to twice a week, mandatory... you can find free therapy through yoru community via non profit if you don't have insurance.
I hope that perhaps one or more of these suggestions will help.
Posted by stargazer2 on September 18, 2007, at 8:55:46
In reply to Re: Forced to terminate current Pdoc after Nardil fail, posted by olysi79 on September 17, 2007, at 23:47:13
ECT is usually given intially 3 times a week until benefits are shown, then it is decreased to 2 times a week, then 1X a week, until a course of 8-12 treatments are given. Some people show no improvement and continued treatment is given until the MD or the pt (more often) say that is enough. After that, maintenance ECT is usually recommended 1x a month. The schedule is highly variable by individual and by MD.
I worked in a ECT dept and I saw many patients who did not have really good trials of medications undergo ECT. The ECT doctor was not an expert in medications and some pts did not get the benefit of expert medication management before ECT was recommended. The ECT doc was not experienced himself and I thought was a bit too eager to give ECT without offering any other alternative. Why would he even if a patient pushed for a longer med trial since ECT presented as the only option.
I was not overly impressed with the outcomes of ECT. I saw some people improve but many did not. Several went onto to commit suicide anyway.
As you can tell from reading many of the posts with MD's not experienced with medication combinations, ECT is probably suggested more often than necessary and if someone is suicidal and medication is not working, the belief is that ECT is the last chance they have. All I know is that when I was suicidal, Seroquel got me out of it and I would use it again rather than undergo ECT.Since I know alot about the procedure, I am very skeptical of it's efficacy. I think it can disrupt the brain enough to change someones' behavior very quickly, but I'm not so sure about it's long term success as a treatment for depression. At least with medications, side effects are mostly reversible but with ECT they are not. Again this is my opinion and not a suggestion that others feel this way. In some cases, ECT is all that is offered as a next step but I believe a next step should be to a psychopharmacologist and that step is almost always skipped.
Stargazer
Posted by cumulative on September 18, 2007, at 12:53:13
In reply to Forced to terminate current Pdoc after Nardil fail, posted by girlnterrupted78 on September 16, 2007, at 23:35:15
** How high did you go with the Nardil?
** Get a new doctor anyway; that guy's an idiot.
** Maybe someone who will augment MAOIs.
Posted by Kneeko on September 19, 2007, at 0:14:47
In reply to Olisy79, Excellent suggestions...ECT specifics, posted by stargazer2 on September 18, 2007, at 8:55:46
You worked in the ECT room and you are saying you were not very impressed with outcomes of ECT? What does that mean statistically?
Posted by tecknohed on September 19, 2007, at 6:29:25
In reply to Forced to terminate current Pdoc after Nardil fail, posted by girlnterrupted78 on September 16, 2007, at 23:35:15
Yes, find a good Psychopharmacologist, a Proffessor (of Psychopharmacology) if poss - that way any requests or suggestions wont have to go 'through' anyone else as you'll be with the top person themself & you wont have to wait for answers.
Sounds like your current pdoc has troubles of his own - the word 'apathy' comes to mind (and a few others!). He is only human after all.
Posted by stargazer2 on September 19, 2007, at 8:03:10
In reply to Re: Olisy79, Excellent suggestions...ECT specifics, posted by Kneeko on September 19, 2007, at 0:14:47
I don't know statistics but my overall impression was more negative than positive. For over a year I saw these patients come in over and over and I was not able to tell if they were any better, the outcomes were murky. Very few indicated that their depression had improved that much. It was a very hard place for me to work because I didn't feel the treatment was as positive as I had been led to believe. I think many underwent the treatment because they were not given any other hope other than ECT. They know it can help but know it may not either. It is used as a last option treatment.
I was particlarly unimpressed with the head MD. He seemed more concerned with numbers treated rather than individual outcomes. He did not push medication to any great level before going right to ECT. I did not see referrals to MD's with polypharmacology experience. He was very unskilled with medication management as I made an obvious recommednation to him to increase a medication that he did not increase as I would have expected a MD to do. Of course there was a financial incentive for him to do ECT and do it frequently. That was obvious to me as he pushed to treat more patients than I felt was safe.
You would have to read studies to get a sense of statistical outcomes. Or google patient who have had ECT for their views of how much it helped them.
Stargazer
Posted by linkadge on September 19, 2007, at 10:25:36
In reply to Kneeko, no stats just first hand observation w ECT, posted by stargazer2 on September 19, 2007, at 8:03:10
The stats on ECT are mixed. The sucess rate on ECT may be low, but this is still considered good as these people are highly treatment resistent.
It does have a very high relapse rate. My psychiatrist will not administer ECT (he won't give me details)
If you are going to ask a person their impressions of ECT, do it a year after they have it.
Linkadge
Posted by stargazer2 on September 19, 2007, at 15:42:28
In reply to Re: Kneeko, no stats just first hand observation w ECT, posted by linkadge on September 19, 2007, at 10:25:36
Maybe a post can be started for those who had ECT to get their feedback of it. Only I guess it would have to be somewhere other than here with medications, not sure though. I would be interested in seeing those results for my own knowledge and this is a great forum to get that information....Anyone here have ECT and can share their results here?
SG
Posted by sam123 on September 19, 2007, at 16:16:43
In reply to Post for ECT outcomes?, posted by stargazer2 on September 19, 2007, at 15:42:28
Posted by sam123 on September 19, 2007, at 16:23:36
In reply to Re: Post for ECT outcomes?, posted by sam123 on September 19, 2007, at 16:16:43
here is quite a bit more:
Posted by stargazer2 on September 19, 2007, at 17:27:05
In reply to Re: Post for ECT outcomes?, posted by sam123 on September 19, 2007, at 16:23:36
Thanks sam123 for sending those links.
I would like to hear specifically how those receiving ECT are doing 6,12,24 months out from their last ECT treatment. It's hard to know if ECT treatments are effective over the long term or just in the immediate post procedural phase.
Also it helps to have a dialogue with someone who has received ECT treatments in the recent past.
I am curious since in each of my really depressed moods, the thought of ECT comes up but I'm too afraid to ever think seriously about it for myself.
Stargazer
Posted by stargazer2 on September 19, 2007, at 17:27:14
In reply to Re: Post for ECT outcomes?, posted by sam123 on September 19, 2007, at 16:23:36
Thanks sam123 for sending those links.
I would like to hear specifically how those receiving ECT are doing 6,12,24 months out from their last ECT treatment. It's hard to know if ECT treatments are effective over the long term or just in the immediate post procedural phase.
Also it helps to have a dialogue with someone who has received ECT treatments in the recent past.
I am curious since in each of my really depressed moods, the thought of ECT comes up but I'm too afraid to ever think seriously about it for myself.
Stargazer
Posted by linkadge on September 19, 2007, at 20:08:57
In reply to Any recent ECT patients who can give feedback, posted by stargazer2 on September 19, 2007, at 17:27:14
ECT is used a lot in the elderly. Elderly people with severe mood disorders are probably less likely to be online to give a rating.
Linkadge
Posted by Phillipa on September 19, 2007, at 20:34:12
In reply to Re: Any recent ECT patients who can give feedback, posted by linkadge on September 19, 2007, at 20:08:57
Doesn't Phoenix girl occasionally post? I remember that name. Phillipa
Posted by sam123 on September 20, 2007, at 10:08:34
In reply to Any recent ECT patients who can give feedback, posted by stargazer2 on September 19, 2007, at 17:27:14
> Thanks sam123 for sending those links.
>
> I would like to hear specifically how those receiving ECT are doing 6,12,24 months out from their last ECT treatment. It's hard to know if ECT treatments are effective over the long term or just in the immediate post procedural phase.
>
> Also it helps to have a dialogue with someone who has received ECT treatments in the recent past.
>
> I am curious since in each of my really depressed moods, the thought of ECT comes up but I'm too afraid to ever think seriously about it for myself.
>
> Stargazer
Sigh. It is always but.....
I will make a note of that.
Posted by brooke484 on September 20, 2007, at 13:15:02
In reply to Forced to terminate current Pdoc after Nardil fail, posted by girlnterrupted78 on September 16, 2007, at 23:35:15
Have you thought about seeing a psychopharmacologist? If you want a list, you have to go to this web site http://www.ascpp.org and send them an email. They will send you a list for your state.
brooke
Posted by twinleaf on September 20, 2007, at 14:10:48
In reply to girlinterrupted78, posted by brooke484 on September 20, 2007, at 13:15:02
Is anyone with TRD considering TMS? I wouldn't dare undergo ECT, but TMS has been very helpful to me over the last four years. Each time, it helps a lot for a few weeks to months. Then, the effect fades away, and I have it done again. No side effects that I've been able to detect.
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