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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by B2Chica on January 28, 2011, at 14:31:09
so i really believe this is where i fall, that or psychotic depression.
but my pdoc still things bipolar.
are we talking symantics here i read that aggitated depression is considered mixed mania.what it comes down to is medicating symptoms and moodstabilizers ALWAYS have made me worse.
so i ask all those here.
how should aggitated depression OR psychotic depression be treated best?
i've only tried a few mood stabilizers but they ALL made me feel worse (cycle,or get manic-y).
Posted by creepy on January 28, 2011, at 15:10:34
In reply to Aggitated Depression, posted by B2Chica on January 28, 2011, at 14:31:09
Agitated depression may not really be mixed state or hypomania. In my case I get that from my PTSD and depression.
lexapro worked well to tame the irritability at a high dose. But it made me apathetic. Lower doses seemed to push me into mild dysphoric, mixed states.
zoloft seems to work well so far at helping the anger.
Im not convinced that agitated depression is indicative of bipolar. Lots of people become irritable in unipolar depression.
If treating depression doesnt resolve the anger them Id look at mood stabilizers and AAPs.
If you want to try mood stabilizers, topamax seems to work well on anger too.
Psychotic depression? Only if you have had delusions or hallucinations at the extremes of your depression.
Posted by Christ_empowered on January 28, 2011, at 15:33:16
In reply to Aggitated Depression, posted by B2Chica on January 28, 2011, at 14:31:09
Psychotic depression is usually treated with a combination of an antipsychotic (preferably, but not necessarily, an atypical) and an antidepressant. From what I understand, the Tricyclic antidepressants are considered a bit more effective than the SSRI drugs in psychotic depression, but b/c of side effects and the potential for death following overdose, newer antidepressants are often used instead.
If you don't want to take an antipsychotic, you could try Lithium. ECT is an option, but I would think you'd want to explore drug treatment first. In resistant cases, an antidepressant+antipsychotic combo can be augmented with another drug, such as lithium or sometimes a stimulant (seems like a bad idea, but I read that some studies showed a response adding Ritalin to treatment).
I think the combo is usually continued for a year. The antidepressant is often continued for a longer period of time, perhaps indefinitely. Talk therapy is an under-used but helpful adjunct to drug treatment.
I'm sorry you're going through this. Good luck to you.
Posted by linkadge on January 28, 2011, at 16:35:16
In reply to Re: Aggitated Depression, posted by Christ_empowered on January 28, 2011, at 15:33:16
I don't really know. Its such a grey area. I don't really think there are great treatments for agitated depression. I was taking TCA + benzodiazapine, which kindof works, but still messy and dirty.
Linkadge
Posted by phillipa on January 28, 2011, at 19:00:23
In reply to Re: Aggitated Depression, posted by linkadge on January 28, 2011, at 16:35:16
Maybe benzo and low dose paxil? That did work once for me? Phillipa
Posted by SLS on January 28, 2011, at 20:53:33
In reply to Re: Aggitated Depression, posted by linkadge on January 28, 2011, at 16:35:16
> I don't really know. Its such a grey area. I don't really think there are great treatments for agitated depression. I was taking TCA + benzodiazapine, which kindof works, but still messy and dirty.
I don't have agitated depression, but I always found nortriptyline to be somewhat calming and more of a mood-brightener than the other tricyclics.
You will find in the literature warnings not to give nortriptyline to agitated patients, but the references to the same citation are ubiquitous: "If the drug is given to overactive or agitated patients, increased anxiety and agitation may occur." I am skeptical that this drug should be contraindicated. I would want to be more sure of myself, though, before recommending it.
- Scott
Posted by linkadge on January 29, 2011, at 8:00:39
In reply to Re: Aggitated Depression, posted by SLS on January 28, 2011, at 20:53:33
I am not really pleased with the use of amitriptyline or nortriptyline for my agitated depressive states.
At first they seem to really help, but then the sedative qualities seem to fade and I almost end up more agitated.
5-ht and histamine blockade might help agitation, but NRI action is not necessarily beneficial. Also, nortriptyline gave me akathesia.
Also, they are antidepressants. If I take even one dose and then stop, I don't sleep well for a week. I think the AD action prevents the deep paralyzing anticonvulsant sleep stages, which are necessary for true homeostatic reset.
I have had sucess with theanine, but around here its so expensive (like $40 a bottle of 60)
Linkadge
Posted by SLS on January 29, 2011, at 12:22:14
In reply to Re: Aggitated Depression, posted by linkadge on January 29, 2011, at 8:00:39
> I am not really pleased with the use of amitriptyline or nortriptyline for my agitated depressive states.
>
> At first they seem to really help, but then the sedative qualities seem to fade and I almost end up more agitated.What about doxepin or trimipramine? Trimipramine might be genotoxic. I know that is a concern of yours.
Although you might not like the idea, perhaps Seroquel would be worth a look. Antidepressant / anxiolytic. If not for you, do you think it might be helpful in agitated depression?
- Scott
Posted by floatingbridge on January 30, 2011, at 4:37:40
In reply to Aggitated Depression, posted by B2Chica on January 28, 2011, at 14:31:09
Hey 2BChica,
I think this is an area where you and your doctors are best keeping an open mind while you (important observer) and your doc(s) carefully observe your symptoms and med reactions--and if necessary reevaluate your treatment. Agitated depression can look or feel like a mixed episode imo.
What makes you or your docs think psychotic depression? It could be, and this is important to know and treat properly.
Ptsd can create episodes of disassociation, which could be observed by some (and felt by the affected?) as psychotic.
I would not wish for you to be unnecessarily medicated for a condition you may not truly have--that's why I'm going on...
I'm hoping you get the right dx and best treatment you need now. Hang in there.
fb
Posted by linkadge on January 30, 2011, at 15:35:32
In reply to Re: Aggitated Depression » linkadge, posted by SLS on January 29, 2011, at 12:22:14
Actually, I was going to mention seroquel. I think seroquel could be a good option for agitated depression.
It is difficult to say though. Antidepressants are indicated for anxiety disorders too, but "agitation" can be different. I think antidepressants can work for ruminative anxiety better than "activation", i.e. psychomotor activation.
Then theres the question of whether agitation is simply not treated, or if its made worse by either the antidepressant qualities or akathesia inducing qualities or both.
Heightened or diminished dopamine function, could theoretically produce agitation.
A low dose of lithium augmenting a sedating SSRI might work. I did ok on celexa 10mg + 600mg of lithium. Probably should have stayed there. Oh well, likely can't go back now.
Linkadge
Posted by floatingbridge on January 30, 2011, at 16:09:03
In reply to Aggitated Depression, posted by B2Chica on January 28, 2011, at 14:31:09
2BChica,
How's it going for you today? Keep us in the loop when you can, o.k.?
peace,
fb
Posted by Phidippus on January 30, 2011, at 21:14:36
In reply to Aggitated Depression, posted by B2Chica on January 28, 2011, at 14:31:09
Psychotic Depression can be comorbid with Bipolar disorder. My depressions are always agitated and sometimes I have psychotic symptoms. Really, the best way to treat this kind of depression is with antipsychotics. I have a lot of success with Zyprexa, Seroquel and Abilify in that area. Haldol is another drug which is great for that kind of abysmal depression. For the worst cases, nothing beats Clozaril.
P
Posted by Solstice on January 30, 2011, at 22:45:27
In reply to Aggitated Depression, posted by B2Chica on January 28, 2011, at 14:31:09
> so i really believe this is where i fall, that or psychotic depression.
>
> but my pdoc still things bipolar.
> are we talking symantics here i read that aggitated depression is considered mixed mania.
>
> what it comes down to is medicating symptoms and moodstabilizers ALWAYS have made me worse.
>
> so i ask all those here.
>
> how should aggitated depression OR psychotic depression be treated best?
> i've only tried a few mood stabilizers but they ALL made me feel worse (cycle,or get manic-y).High dose Lamictal has been miracle-ish for my daughter. Tamed her emotional volatility that could have easily been described as aggitation.
Solstice
Posted by morgan miller on January 31, 2011, at 0:12:32
In reply to Re: Aggitated Depression, posted by linkadge on January 30, 2011, at 15:35:32
>A low dose of lithium augmenting a sedating SSRI might work. I did ok on celexa 10mg + 600mg of lithium. Probably should have stayed there. Oh well, likely can't go back now.
I'd like to think that you could if you felt it was necessary to at least give it another go. I know you don't think there is an appreciable difference between Celexa and Lexapro, but trying as very low dose of Lexapro with a little lithium could be an option down the road. If you trust some the the pharmacies out there, you can get a hold of some very cheap escitalopram generic. Heck, even brand Lexapro is very reasonable.
Morgan
Posted by B2Chica on January 31, 2011, at 15:20:22
In reply to Re: Aggitated Depression, posted by linkadge on January 30, 2011, at 15:35:32
have had some weird stuff going on but doing mostly ok.
thanks for all the responses.
been on seroquel (back in the day) and had cognitive blunting. best sleep i've ever had but made me dumb as a box of hammers.
lexapro i've been on and i couldnt keep my eyes open past 8:00 and with two little kids that is not an option.on zyprexa works like a charm as always but i'm having to go back up to 10mg. and thats when i tend to gain weight.
currently on pristiq (and still not convinced its even doing anything yet.
zyprexa 5/10mg.
gabapentin 600mg bid and xanax prn.i think my pdoc said haldol is pretty similar to the zyprexa? do i remember that right, just a stronger drug?
and i put in the psychotic depression because i have auditory and visual illusions (not really halucinations) well, the auditory kinda are, but i'm aware that they are false and my pdoc says that is a sign of psychotic depression.
i think the anger is related mostly to my ptsd. and yes i dissociate pretty bad but i (after how many years of therapy) am pretty aware of what is depression and what is the dissociation. (finally).
anyway. if the pristiq isn't working i need to find another AD, i'm assuming the doxepin and trimipramine are those.
been on abilify and that coincided with the beginning anger so i stopped the abilify. but not sure now if the anger was from that or from ptsd? i just dont know. i seem to get so d@Mn erratic lately.
i know i've asked this before but was it metaformin that people use to help with weight gain of zyprexa?
i meet with pdoc this saturday and would like to have some ideas for him.
thanks all
b2c.
Posted by floatingbridge on January 31, 2011, at 22:27:03
In reply to Re: Aggitated Depression, posted by B2Chica on January 31, 2011, at 15:20:22
B2Chica,
How long have you been on pristiq. I think it took awhile to kick in. Not sure either what it did, but I found it had very few sides and little brain fog. I did take it at night. Did not find it as stimulating or anxiety provoking as some other ad's.
Wish I had more to offer. Sounds like you have some good people working with you. Hope that's true.Best,
fb
Posted by linkadge on February 1, 2011, at 18:29:05
In reply to Re: Aggitated Depression, posted by morgan miller on January 31, 2011, at 0:12:32
I agree, but I don't think its an option with my doctor. See, I've (innadvertently) painted different pictures of medications with my current doctor. I think my story changes somewhat, because I'm never sure myself. I think my story about what meds worked and what meds didn't changes, just as my own personal preceptions do.
So, I think (at one point) said I hated lithium. If I all of a sudden express interest in trying it again, I will possibly look inconsistent (or unsure at the least).
Linkadge
Posted by roscopeeco on February 2, 2011, at 4:56:17
In reply to Aggitated Depression, posted by B2Chica on January 28, 2011, at 14:31:09
Well you have your answer about mood stabilizers. Don't take them.
This is the end of the thread.
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