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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by meltingpot on April 27, 2009, at 15:54:13
Hi,
I'm just wondering if there is any hope for me. Has anyone spent a long time trying to find a med or combination of meds to work for depression and anxiety. Then finally found something that worked only to have it stop working a few years later but then gone onto find something that works just as well.
I spent two years struggling with depression and a lot of anxiety to eventually get a response to Seroxat 40mg but then two years later it stopped working in that apathy and anhedonia came back.
For the last four years I've tried to find something else to work or to add to the Seroxat to make it work the same as before to no real avail.
Has anyone else here been in the same situation and found something eventually to work???
Thanks.......Denise
Posted by Zana on April 27, 2009, at 16:06:58
In reply to Poop out remedies - success stories, posted by meltingpot on April 27, 2009, at 15:54:13
Oh boy are there a lot of stories here that fit your profile. I think everyone who posts here has had a beloved med go bad and struggled to recapture the glow. I think the med trip goes on. I think you have to keep trying augementation strategies. I think you have to keep trying new drugs. Post a list of your current and previous meds. What have you tried already? That will give people an idea of what might be helpful that you haven't yet tried.
It's a long hard struggle with these meds. Hard to know, sometimes, how much they help and how much they hurt.
Hope you find just the right mix, for now.Zana
Posted by jms600 on April 27, 2009, at 17:02:07
In reply to Poop out remedies - success stories, posted by meltingpot on April 27, 2009, at 15:54:13
You could try augmenting the antidepressant with a low dose of lithium - say 400-600mg. I have read somewhere that it can help stop the brain becoming tolerant to the beneficial effects of antidepressants.
Posted by Phillipa on April 27, 2009, at 17:23:15
In reply to Re: Poop out remedies - success stories » meltingpot, posted by jms600 on April 27, 2009, at 17:02:07
Hi Denise still no luck? I'm so sorry. There is an answer for you. Love Phillipa
Posted by bleauberry on April 27, 2009, at 18:37:14
In reply to Poop out remedies - success stories, posted by meltingpot on April 27, 2009, at 15:54:13
Probably the best bets, if you haven't tried them already, to give rebirth to your med and have it last a long time would be:
Provigil
Nortriptyline
Desipramine
SavellaI could have listed others as well, except I felt they would have a high probability of early poopout or tolerance. Those include Wellbutrin, Ritalin, Adderall, antipsychotics, mood stabilizers.
Ok, flash forward, you've tried all the above four one at a time with your current med, and you've switched entirely to a different SSRI, but things are still not going well. Don't feed the merrigoround game any longer. Time to switch mechanisms completely. Time to say goodbye to the whole reuptake inhibition thing. The time and justification for Nardil or Parnate has arrived. Rather than artificially damming up a single or two neurotransmitters at the synapse site with a foreign molecule, let all of the neurotransmitters increase globally by preventing their destruction.
But honestly I think adding a bit of noradrenergic boost to your med stands a good chance of reviving things. That's why I listed the above four meds.
Posted by zana on April 28, 2009, at 9:43:51
In reply to Re: Poop out remedies - success stories, posted by bleauberry on April 27, 2009, at 18:37:14
Boy, bleauberry, your stance on MAOIs gives me hope. Right now I am having good luck with Pristiq augmented with provigil, gabapentin, klonopin, remeron and seroquel (the last two I am in the process of weaning off.) But I know the SSRI/SNRI will poop out eventually. And making more neurotransmitters rather than blockading a couple makes a whole lot of sense to me. Really glad for your imput. A decade. You should get a medal.
Zana
Posted by Cseagraves on April 28, 2009, at 13:13:11
In reply to Poop out remedies - success stories, posted by meltingpot on April 27, 2009, at 15:54:13
Meltingpot.
Well, with everything being said and after everything not working for me, I am now on my second day of Nardil. So far, so good. No ugly side effects as of yet, and hopefully won't.
I only started on 30mgs per day and will probably vamp it up to 45 in a couple of days, but will keep you posted.
Best of luck to you in your search.
Hugs,
Courtney
Posted by Barney on April 29, 2009, at 10:45:07
In reply to Re: Poop out remedies - success stories, posted by Cseagraves on April 28, 2009, at 13:13:11
Hi!
There seems to be a lot of research into Treatment Resistant Depression.
However, it seems to focus on:
1. medication not working at all; or
2. medication only parially working.Is there *any* research on "poop out"?
This is a vitally important aspect of TRD that seems to be currently ignored.
I have had this for ten years. Lost my career and formed no close relationships. I am restarting my life ten years later by beginning a med degree in September.
Posted by floatingbridge on April 29, 2009, at 20:57:12
In reply to Re: Poop out remedies - success stories, posted by Barney on April 29, 2009, at 10:45:07
> Hi!
>
> There seems to be a lot of research into Treatment Resistant Depression.
> However, it seems to focus on:
> 1. medication not working at all; or
> 2. medication only parially working.
>
> Is there *any* research on "poop out"?
>
> This is a vitally important aspect of TRD that seems to be currently ignored.
>
> I have had this for ten years. Lost my career and formed no close relationships. I am restarting my life ten years later by beginning a med degree in September.
>
>Wow! I wish you the best and lots of courage. I've lost many years, career, and friends due to depression and am just beginning to think of how to begin again. Is something working for you that'd you'd like to share?
Candace
Posted by Barney on April 30, 2009, at 17:30:08
In reply to Re: Poop out remedies - success stories, posted by floatingbridge on April 29, 2009, at 20:57:12
Hi,
I hit rock bottom.
I never experienced major depression; it was always a severe form of dysthymia.
It drove me insane, I was like a person in solitary confinement.
Even negative feelings seemed better at times than the *lack* of feelings I experienced for years on end.
I am not 100% recovered yet.
My social skills are impared because the illness reduces your ability to spot social and emotional cues when interacting with other people.I sometimes felt like a deafman who used to be able to hear. In such circumstances they can continue to speak, even if they cannot hear, however, this power is eroded and distorted overtime as they begin to forget what the human voice sounded like. It felt like that with my emotions.
The worst part was at the beginning.
First, the drugs worked and I leaped forward, had great experiences, however, the drugs began to *poop out.* I walked into a nightmare with memories and experiences I want to forget.The onset of the illness was particularly bad because I had had such a postitive experience with SSRISs - it was as if a light had been switched on and I could see and feel for the first time in my entire life. But then poop out happened, and I went from feeling alive to feeling nothing. It was indescribable horror. Horror. A howling greyness that bleached my mind.
Anyhow, I am currently not on any meds, my life hit rock bottom. When I was at my lowest I realised I could not continue with my original career. I realised I couldnt wait until I got better to put myself in a postion where I could have a good life. I had to start, slowly, VERY slowly, when I was ill - so I would be able to continue with my life when I "woke up". I sat and thought about possible careers. Some careers are stronly impared by depression, e.g. IT, accountancy, etc. So I decided to try medicine. I went to night school and surprised myself by slowly getting good at science.
It has been a nightmare and I have experienced pain and humiliations that I try not to think about.
I read up about depression.
I read other peoples accounts of their experiences, including coming though it. This was very cathartic. Especially when I had nobody to talk to about it.
I had a goal and never quit.
It has kept me focused for the past seven years.
It has kept me alive and and it has kept me going forward.To regain my health I know I need to have effective SSRIs. This is why finding information about "poop out" is so important.
I have TRD, however, most of the research seems to focus on those who havn't responded at all to meds, or only partly. No research seems to be underway into those who initially responded to meds, but the effectiveness wore off.The current rate of research into depression is impressive, google "pubmed" and search "depression", every other day there are new research papers on depression. Incredible.
However, nothing on "poop out".
Posted by floatingbridge on April 30, 2009, at 18:30:06
In reply to Re: Poop out remedies - success stories, posted by Barney on April 30, 2009, at 17:30:08
SSRI's and SNRI's initailly worked for me, though never completely, then quit, so I've bounced around a bit. Am now on prestique and trying to deal with anxiety. Though I implored my doc to try parnate, he says he's not ready to try that yet. I wish I had more experience to share with you and the group....
What courage we must all muster!
Candace
Posted by desolationrower on April 30, 2009, at 23:19:13
In reply to Re: Poop out remedies - success stories, posted by Barney on April 30, 2009, at 17:30:08
look for tachyphylaxis (with other relevant keywords)
-d/r
Posted by meltingpot on May 2, 2009, at 7:29:33
In reply to Re: Poop out remedies - success stories, posted by Zana on April 27, 2009, at 16:06:58
Hi Zana,
It's really good of you and the others to even go out of your way to try and offer advice. I do really appreciate it.
Age 24 to 29 - Started taking tricyclic Prothiaden 75mg and it worked very well and very quickly. Dont look back. Prothiaden seemed to give me a new lease of life, I can honestly say I never felt better. I felt cured and grateful that I had at last found something to help.
Age 29 prothiaden seemed to stop working as well.
Age 29 to 31 20mg of Seroxat Seroxat worked wonderfully. Get a really good job at IBM meet my current boyfriend. I was very happy at this point.
Age 31 Decided to come off Seroxat whilst it was still helping as I didn't want to become tolerant to it and I wanted to see if I would do ok without drugs.
Age 31 to 35 No meds and depression free apart from the odd day here and there.
Age 35 Had just been given a rise at IBM, was going to the gym regularly and still seeing the same boyfriend we still get on ok, no real life stressors going on. Start feeling like something is wrong. Vague aches and pain in my spine, jaw constantly tense, keep feeling cold. Start having bad dreams, Some paranoia at work. Having problems concentrating, feeling very tense all of the time. After work going home and just going to bed. Think maybe I just need a holiday so book a holiday to Portugal. However, part of me is worried about going on holiday. Keep myself distracted by planning the holiday, booking tickets etc. The morning of the flight, I feel awful, I want the plane to crash as Im not sure Im going to be able to keep up a front during the week. We get to Portugal and I feel no sense of pleasure about being on holiday, I feel suicidal, weak, disorientated and very scared. Spend most of the week just walking, walking and walking and feeling very scared and suicidal.
Get back from the holiday and from 2001 to 2003 go through the following medications. During this period Im still working at IBM and there are no major stresses in my life apart from my depression.
Seroxat 20mg (approx 1 month) Extreme anxiety, Suicidal thoughts, pacing up and down.
Sertraline 50mg slight lift in mood but again anxiety bad, still suicidal thoughts.
Prozac and lithium (1 month) Slight lift in mood but still a lot of anxiety, still suicidal thoughts.
Prothiaden 300mg and prozac (approx 1 month). No improvement.
Effexor (3 months) 150mg Still feel anxious on it although not as anxious as on SSRIs, no lift in mood.
Mirtazapine 15mg (about a month) Extreme anxiety.
Lamictal (3 months) Dont feel as though Im taking anything.
Prothiaden Bad anxiety and suicidal thoughts.
Nardil (a month) Anxiety not so bad but still feel depressed and very detached on it.
Age 37 am still managing to do my job at IBM Dr Patel puts me on 40mg of Seroxat and within 4 days I feel as though Ive been forgiven, anxiety goes, suicidal thoughts stop, start wanting to do pleasurable activities again. Start enjoying life. Im still at IBM but Im actually starting to enjoy my work again. Still seeing the same boyfriend but start going out more socialising. Go on holidays to Goa and Vancouver, even start having piano lessons.
Age 39 Still at IBM, no changes in my life but suddenly start to feel depressed again, apathetic and not enjoying the things I had been enjoying, also start to feel uneasy and edgy again although not suicidal. Later on that year Im made redundant from IBM.
Age 39 to 40 Trying adding lamictal, T3 hormone, buspar, mirtazapine to Seroxat (give each one about a months trial) but no change really. Still not feeling suicidal but feel depressed and not interested in anything. Start doing contract work to keep myself busy and start doing voluntary work at Cancer Research on a Saturday to keep myself busy. Purchase a flat but dont really feel excited about it.
Tried Cymbalta for about a month and very anxious on it for the whole month, stopped it.
Age 41 Psychiatrist put me on Lexapro which seemed to start helping after two weeks but I was still having some anxiety and tension on it and still didn't really feel as though I was enjoying life or looking forward much. However felt stronger within myself and had more motivation to work but didn't really enjoy the things I had been enjoying.
Age 42 (2008) Ianaged to get a good contract position at E-on, everything ok situation wise and have been working there since May. Around September the Lexapro seemed to stop working as well in that I started to have a lot of that horrible anxiety, very bad dreams, start to lack motivation at work. Tried switching back to Seroxat to no avail. Back on Lexapro feel as though Im getting worse, losing weight, pacing a lot, vomiting, on one occasion not sleeping for three nights.
Age 42 (2009) Feeling sucidal again, Zyprexa is helping with the anxiety but not the depression. Contract finishes with E-on end of February but to be honest by this time I felt relieved.
Present day - Have been taking clomipramine now for approximately eight weeks, still having sucidal thoughts, sleep is ok and anxiety seems to have gone but I get very tired easily and am spending a lot of time sleeping. I am very worried that the SSRIs have completely stopped working for me and that somehow, somewhere along the line this depression has become completely resistent to medication. Zyprexa still helps with the anxiety though.
Thanks.........Denise
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Posted by meltingpot on May 2, 2009, at 7:41:13
In reply to Re: Poop out remedies - success stories, posted by bleauberry on April 27, 2009, at 18:37:14
Hi Bleuberry,
Thanks for thinking about this for me. I'm currently on Clomipramine (anafranill) 230mg, have been on it for about eight weeks and so far the anxiety seems to have abated but I just feel very tired all of the time and unenthusiastic about most things, kind of like the Seroxat when it stopped working. I can just about manage to go to work but the evenings I have no energy to do anything and so I am tending to sleep a lot when not at work.
Why do you think those particular drugs that you have listed might help?
Also, I have always found Zyprexa 10mg very good at calming me down but for some reason I don't initially like how I feel after taking the Zyprexa but then a few days after start start to feel quite good, which is strange.
I have tried Nardil about three times, each time I took it for about a month, each time it seemed to help with anxiety but not my depression. Does that mean that Emsam or parnate would not help ne either?
I'm not sure why the drugs are not working, I feel like whatever ususally happens in the brain when they do kick in is not happening with me. But I'm not sure what that is. Could it be that I have less 5HTP receptors now and so the drugs have less receptors to work on?
Also, I know that tryciclics tend to affect a lot of receptors besides serotonin receptors and that's why the SSRIs are used more now but do the Tryciclics act on the exact same 5HTP receptors as the SSRIs. I was thinking that perhaps maybe if I stayed on this clomipramine for a long time (even though I don't feel particularly good on it) then if I switched back to Seroxat later it might work. But then having said that, if the clomipramine is hitting the same 5HTP receptors as the Seroxat did then it's not going to make any difference. Do you see where I am coming from?
Denise
Posted by SLS on May 2, 2009, at 8:26:25
In reply to Re: Poop out remedies - To bleuberry, posted by meltingpot on May 2, 2009, at 7:41:13
> I have tried Nardil about three times, each time I took it for about a month, each time it seemed to help with anxiety but not my depression. Does that mean that Emsam or parnate would not help ne either?
No. Each of those drugs are different enough pharmacologically to demonstrate differences clinically. I respond more consistently to Parnate than I do to Nardil. Emsam made me feel worse.
Sometimes you are better off not trying to convince yourself that you can pick and choose drugs based entirely on personal theories. Clomipramine gets some people well who weren't helped sufficiently by SSRIs. That is probably a better reason to try it than attempting to justify its use based upon what little is understood by science regarding the illness and the drugs that treat it.
I would use personal theories to help discover and include drugs to try rather than exclude drugs from consideration. It is not useless to inventory drugs based upon those pharmacological properties that science has thus far reported. However, I think it is helpful to admit the same kind of uncertainty regarding the phenomenology of mental illnesses that is clearly demonstrated and admitted to by scientists.
I am more ignorant than most people give me credit for. Using big words does not guarantee understanding. I guess I know enough to know how much I don't know.
:-)
Keep thinking!
- Scott
Posted by meltingpot on May 2, 2009, at 13:34:26
In reply to Re: Poop out remedies - To bleuberry » meltingpot, posted by SLS on May 2, 2009, at 8:26:25
Scott,
Thanks for your advice, I just feel as though I have hit this kind of impasse, the drugs do so much and then just seem to do no more and I get the same thing with every drug I try.
Clomipramine is not working properly for me and it feels pretty much the same as Seroxat did when it stopped working. I can function ok, anxiety is not so bad but I am so tired all of the time, I feel like I have have this constant tension, in my face, head, neck and spine. I don't really call my life much of a life at all.
There must be some method in all of this madness, that's the only thing that gives me any comfort is that maybe this new (good psychiatrist) will be able to help me by using some kind of science because she is one of the few here in the UK who actually puts some thought behind it but from what you say it doesn't matter what psychiatrist I see because it's all just a crap shoot anyway. This psychiatrist I am seeing now is no more likely to get me better than a psychiatrist who knows less about psychopharmacology.
Denise
Posted by SLS on May 2, 2009, at 15:15:32
In reply to Re: Poop out remedies - To Scott, posted by meltingpot on May 2, 2009, at 13:34:26
Hi Denise
> Thanks for your advice, I just feel as though I have hit this kind of impasse, the drugs do so much and then just seem to do no more and I get the same thing with every drug I try.
I know the feeling well. I may still be in that predicament myself. That is why I went ahead and added memantine at this juncture.
> Clomipramine is not working properly for me and it feels pretty much the same as Seroxat did when it stopped working. I can function ok, anxiety is not so bad but I am so tired all of the time, I feel like I have have this constant tension, in my face, head, neck and spine.
It sounds almost like the beginnings of serotonin syndrome.
> I don't really call my life much of a life at all. Again, I know the feeling well.
> There must be some method in all of this madness,
I think doctors come to create their own methods of treating people based upon the information they are presented with and their own clinical experiences.
> that's the only thing that gives me any comfort is that maybe this new (good psychiatrist) will be able to help me by using some kind of science because she is one of the few here in the UK who actually puts some thought behind it
Psychopharmacology might be more of an art than a science at this point in its evolution.
There are some doctors who try to use imaging studies to help choose treatments. Others have composed elaborate algorithms and flow charts. Science has tried to produce biological tests for affective disorders for many years, but I don't know the extent to which any of these methods are to be found in clinical practice.
> but from what you say it doesn't matter what psychiatrist I see because it's all just a crap shoot anyway.
> This psychiatrist I am seeing now is no more likely to get me better than a psychiatrist who knows less about psychopharmacology.
I was hoping not to demonstrate black-and-white thinking on this matter, but I know that is how I may have come across to you. I do think that some doctors are much better than others at diagnostics and making treatment decisions.
I said, "I would use personal theories to help discover and include drugs to try rather than exclude drugs from consideration. It is not useless to inventory drugs based upon those pharmacological properties that science has thus far reported."
This is not an all-or-nothing approach. I just wanted to impress upon you that to exclude Parnate from consideration based upon it being of the same "class" of drugs as one that you did not respond to would be premature.
See if you can find a smart doctor with a good memory and a little humility. I think part of the first visit to a new doctor should include a screening by the patient of the doctor. I have been lucky for the most part, but I have walked out on a few. It might not hurt to get other medical opinions, even if you decide to stay with your current doctor. Actually, it would be interesting to find out what other doctors consider to be the state of the art. I might be well behind the times, after all.
Which anticonvulsants have you tried?
- Scott
Posted by Barney on May 2, 2009, at 21:43:01
In reply to Re: Poop out remedies - To Scott, posted by SLS on May 2, 2009, at 15:15:32
Re: Doctors
My doctor refuses point blank to accept that anti-depressants poop out. She claims that this has never happened to any ANY patient in her care.
I have noted that there is growing research that clearly indicate the Treatment Resistant Depression exists. She obsfucates and does nothing.
It is almost as if to admit they don't work would mean she is powerless.
She recently raved about some ssri guru she saw at a conference.
She has also suggested I find religion. I have no qualms about this. However, when I calmly pointed out some of the hypocisy with religious types, she didn't like it.
She is the second doctor in this medical practise I have seen. Both of them refuse to accept SSRISs don't work.
The first doctor even refused to accept that I felt ill coming off an SSRI. He said there was no medical evidence to suggest there were withdrawl symptoms! I pointed out the research on this and, hey presto, he didn't like it.
This is not good.
Posted by Meltingpot on May 10, 2009, at 8:12:05
In reply to Re: Poop out remedies - To Scott, posted by Barney on May 2, 2009, at 21:43:01
Hi Barney,
I can't believe your doctor doesn't believe that poop out exists, what planet is she on???
It's really frightening to think that there are psychiatrists out there who think there is no such thing as poop out or tolerance and to think that a psychiatrist does not believe you get withdrawal symptoms comming off an antidepressant! They should be struck off!
If a psychiatrist said that to me, that would immediately put me on a bad footing with them. Why don't you switch to a psychiatrist who knows what they are talking about.
Denise
Posted by Meltingpot on May 10, 2009, at 8:42:35
In reply to Re: Poop out remedies - To Scott, posted by SLS on May 2, 2009, at 15:15:32
Hi Scott,
How is it going with the memantine? I thought you had tried that before??
You are right, I should not discount medication solely because I have not responded well to another medication with the same mode of action. I'm willing to try anything because I have nothing to lose. I can't be any worse than I am when I come off medication completely.
The psychiatrist I am seeing currently is about the best one I've seen so far, in fact she is the only one who has ever asked me to complete a Becks depression inventory before and after taking a medication. She also seems very knowledgeable on psychopharmacology. I just feel pretty hopeless as it seems so long since I felt any good and the longer I continue to feel like this the more trapped I feel. I'm just tired of it as I guess you must be too.
The only anticonvulsants I have ever taken are Lamictal and Tegretol, neither did very much for me, although 400mg of Lamictal seemed to help with the anxiety it also made me really, really tired and heavy.
Do you really think that this tension I'm experiencing could be due to the beginnings of Serotonin Syndrome??
I know that after going through two years of hell and trying what seemed like umpteen medications, Seroxat high dose did start to work back in 2003 but for some reason stopped being effective. I would like to recapture the feeling I had in 2003 and the only possibility I can think of is by switching to a completely different drug, staying on that for a year and then switching back to Seroxat in the hope that it will work again.
This probably sounds like a stupid question but do tryciclic medications act on exactly the same 5HTP receptors as SSRIs. I mean I know that tryciclics are not prescribed as much because they act on a lot of other receptors as well but with regards to the 5HPT receptors, do they act on the same ones?
My thinking is that if perhaps I stay on a tricyclic for a year (currently on clomipramine) then at some point if I switched back to the Seroxat then maybe it would work as well as it did before. Sounds like I'm clutching at straws I know but I am desperate for any ideas.
Denise
Posted by Barney on May 11, 2009, at 9:06:59
In reply to Re: Poop out remedies - To Barney, posted by Meltingpot on May 10, 2009, at 8:12:05
Meltingpot - THANK YOU! *hug*
You don't know what those kind words mean to me.
It feels like a huge weight has been lifted, someone believes me about my experiences.When you're feeling ill and vulnerable you don't want to be confronted by such ignorance and lack of understanding. She didn't even know what dysthimia was!
The doctor is a general practitioner not a psychiatrist. I will have to find a new doctor, this one is ignorant and has not helped me get better. I have been reading about augmentation, and so on. She has never, ever mentioned any of this.
Phew. Again, thank you. I feel much better as I write this.
Posted by meltingpot on May 11, 2009, at 15:01:03
In reply to Re: Poop out remedies - To Barney, posted by Meltingpot on May 10, 2009, at 8:12:05
Hi,
Glad I managed to make somebody feel a bit better :-)
Denise
This is the end of the thread.
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