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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by floatingbridge on August 14, 2011, at 19:16:16
Great two threads in a row. Guess my mood :-/
Since the whole withdrawal/restart shebang, I wake up in an o.k. mood. This is very new to not wake to dread.
Now it is in the evening. From late afternoon onward there is a sense of dread. I usually feel pretty bleak, blah, blah, insert your word here along with crying behaviors.
My new doc's quick remark was that this could be a natural resetting of my circadian something clock. Maybe. He was
speculating. I guess I didn't flat out say, hey, I still cry every day and on top of that, stomachaches.How long can one be depressed like this? Before the major depression, there was the ten thousand years of dysthymia. I just can't go back to that.
Someone tell me that I have been through a lot and am still deep in the hole and that I will get out and maybe you can mention a reasonable timeframe of expectation and what I cannot expect from medication.
Thanks.
Posted by Phillipa on August 14, 2011, at 23:33:40
In reply to Change in mood rhythm/recovery time, posted by floatingbridge on August 14, 2011, at 19:16:16
FB you are already getting out as the morning dread seems to be major depression and night dysthymia and anxiety. Well no fact just thought. Love Phillipa
Posted by Dinah on August 15, 2011, at 7:35:32
In reply to Change in mood rhythm/recovery time, posted by floatingbridge on August 14, 2011, at 19:16:16
Is it possible that you are looking for the euthymia that sometimes comes with a medication adjustment? That mild good hypomania that inevitably wears off?
For me, even the best medication brought only incremental change in my overarching mood. First absence of the feeling that I'd stuck my wet finger in a light socket. Then the lifting of suicidal ideation. Then a decreasing of tearfulness. And much later the ability to actually feel joy, to feel good. I'd pretty much given up. Not feeling awful helped to get me a toehold out of the pit, but it took a while of everyday life and having the time and energy to spend on it before I started feeling good as opposed to not terrible, then not bad.
But that's me.
Posted by floatingbridge on August 15, 2011, at 9:20:28
In reply to Re: Change in mood rhythm/recovery time, posted by Dinah on August 15, 2011, at 7:35:32
Does it eventually wear off for you?
I'm not sure I have much experience with euthymic mood. I have briefly (I mean less than an hour) after which I might become sleepy (I call this a brown out, as in the way the lights dim before a blackout , or did when I was a child. Now they just seem to go out.)
Gosh, Dinah, how long have you really worked on your recovery? I have a sense that somehow you have come a long way and done some real work. But I am only just really getting a sense of this now.
Last night I (in the 'bad' time of day) said maybe I should just accept having a mystery ailment and be done with it. Not look to psychiatry to fix what it cannot. Then, of course that led to thinking about my son and being there for him. In a reasonable mood would be nice.
Posted by SLS on August 15, 2011, at 11:40:14
In reply to Re: Change in mood rhythm/recovery time » Dinah, posted by floatingbridge on August 15, 2011, at 9:20:28
> Last night I (in the 'bad' time of day) said maybe I should just accept having a mystery ailment and be done with it. Not look to psychiatry to fix what it cannot. Then, of course that led to thinking about my son and being there for him. In a reasonable mood would be nice.
What is your best time and worst time of day?
- Scott
Posted by floatingbridge on August 15, 2011, at 11:45:40
In reply to Re: Change in mood rhythm/recovery time » floatingbridge, posted by SLS on August 15, 2011, at 11:40:14
> > Last night I (in the 'bad' time of day) said maybe I should just accept having a mystery ailment and be done with it. Not look to psychiatry to fix what it cannot. Then, of course that led to thinking about my son and being there for him. In a reasonable mood would be nice.
>
>
> What is your best time and worst time of day?
>
>Scott, until Emsam (like this July) mornings were bad. As in bad. I brightened as the day went on. Evenings would be good.
Now (as of July) my mornings are dread free. It is my small window of being alright. Let's say the decline begins at around noon, but I can work it until 5:00 or so. Then it can be quite dysphoric/hopeless, all those things.
I don't understand the switch.
> - Scott
Posted by SLS on August 15, 2011, at 12:03:20
In reply to Re: Change in mood rhythm/recovery time » SLS, posted by floatingbridge on August 15, 2011, at 11:45:40
> mornings were bad. As in bad. I brightened as the day went on. Evenings would be good.
If you are treating MDD, it is likely that your depression is of the endogenous (non-atypical) type. Prior to beginning Emsam, you had followed the typical pattern of a tricyclic responder.
- Scott
Posted by floatingbridge on August 15, 2011, at 14:03:09
In reply to Re: Change in mood rhythm/recovery time » floatingbridge, posted by SLS on August 15, 2011, at 12:03:20
> > mornings were bad. As in bad. I brightened as the day went on. Evenings would be good.
>
> If you are treating MDD, it is likely that your depression is of the endogenous (non-atypical) type. Prior to beginning Emsam, you had followed the typical pattern of a tricyclic responder.
>
>
> - ScottThanks for the input, Scott.
Let me see if I understand the terms used in this post.
Prior to Emsam, depression seemed endogenous, based on timing of mood. Endogenous is non-atypical. Non-atypical
(endogenous) depression does not respond well (in theory) to mao-inhibitors? Am I carry this concatenation correctly?
---------------If so, I guess I had held out hopes that if Emsam fails there would be parnate or Nardil.
When I did a quick read of endogenous depression, I found
mu opoid treatment was promising (though elusive to obtain.). This re-enters that escalation terrain, because I haven't seen it demonstrated that such therapy does not escalate.Tricyclic responder. Back to the reading. I have not tried Ami. Usually I do not tolerate meds with much NE action.
Depression has morphed over the years :-/ with episodes of more melancholic, agitated, intersspersed with more lethargic *atypical* I assume due to ability of mood to lift with circumstance and situation only to return to baseline crummmy.
So much thinking going on. Thanks again!
Posted by SLS on August 15, 2011, at 14:30:02
In reply to Re: Change in mood rhythm/recovery time » SLS, posted by floatingbridge on August 15, 2011, at 14:03:09
> > > mornings were bad. As in bad. I brightened as the day went on. Evenings would be good.
> > If you are treating MDD, it is likely that your depression is of the endogenous (non-atypical) type. Prior to beginning Emsam, you had followed the typical pattern of a tricyclic responder.
> Thanks for the input, Scott.
>
> Let me see if I understand the terms used in this post.Note that I qualified my statements as being predicated on the condition that one be treating MDD. I am not sure that MDD is what you are suffering from.
> Prior to Emsam, depression seemed endogenous, based on timing of mood. Endogenous is non-atypical.Yes.
> Non-atypical
> (endogenous) depression does not respond well (in theory) to mao-inhibitors?No. Endogenous depression can respond to MAOIs. The dichotomy of treatment is not absolute. It represents a trend observed over the years. The last time you listed all of your symptoms, I had thought Nardil might help.
No guarantees.
:-(
- Scott
Posted by floatingbridge on August 15, 2011, at 14:34:29
In reply to Re: Change in mood rhythm/recovery time » floatingbridge, posted by SLS on August 15, 2011, at 14:30:02
But what is this about guarantees? :P
Posted by B2chica on August 15, 2011, at 15:46:04
In reply to Re: Change in mood rhythm/recovery time » floatingbridge, posted by SLS on August 15, 2011, at 14:30:02
Scott. this was a very interesting post(s) for me.
i've never responded well to SSRI's and only Pristiq (Effexor was Horrible).
respond(ed) well to wellbutrin (but pooped out) and ritalin/adderall
did well on zyprexa
terrible on any mood-stabilizers
only tried 2 tca's remeron and trazadone-nothing.should i try another TCA?
should i just jump in and try Maoi next...i have always made the assumption that dopamine was my key.
any thoughts?-wish there were more meds that worked with dopamine receptors... :(
thanks.
b2c.
Posted by SLS on August 15, 2011, at 17:18:23
In reply to Re: Change in mood rhythm...SLS » SLS, posted by B2chica on August 15, 2011, at 15:46:04
Hi B2C.
> only tried 2 tca's remeron and trazadone-nothing.
Neither one of these drugs is a TCA. Examples of TCA are: imipramine, desipramine, amitriptyline, nortriptyline, doxepin, trimipramine, protriptyline, amoxapine, and clomipramine.
For depression, I prefer nortriptyline and desipramine because they have relatively mild side effects compared to the others. For OCD, clomipramine is the most effective. I am currently taking a combination of Nardil and nortriptyline.
> should i try another TCA?You haven't tried one yet, I don't think. :-)
> should i just jump in and try Maoi next...
I don't know. What are the main symptoms of your illness?
> i have always made the assumption that dopamine was my key.Can you detail for me the reasons you have for coming to this conclusion? It would be helpful.
- Scott
Posted by Dinah on August 15, 2011, at 20:19:40
In reply to Re: Change in mood rhythm/recovery time » Dinah, posted by floatingbridge on August 15, 2011, at 9:20:28
I think I went on Luvox in January 1997, and was on for four years. I don't think I started Risperdal until Fall 2005. Since then, I've learned to use an as needed basis that works for me.
But I'm not sure any medication ever made me feel good. That was a slower process that arose from not feeling awful then working my way up. It took me a good long while to feel safe in not feeling bad. To realize that if I started to feel bad, I had the tools to keep me from sliding too far. It took me a long while to recognize that while I feel like I've always felt the way I feel now, and I always will feel that way, it isn't really true. Things come and go and come and go.
Of course, when I'm feeling really bad, I tend to forget that.
Posted by floatingbridge on August 16, 2011, at 2:06:08
In reply to Re: Change in mood rhythm/recovery time » floatingbridge, posted by Dinah on August 15, 2011, at 20:19:40
Thanks Dinah. Your support and listening to your story and process here has been really a help to me in sorting out my own thoughts and experiences. Truly.
Still digging out. Today was alright, so I try to bank it against the not so good times.
Risperdone has been shelved to let the Emsam do what it will do. I had some kind of hives yesterday/today. Unusual for me. Not the death rash or anything. So when the doc said either increase or stop for now, I chose the latter for now.
Oh well :-)
Posted by B2chica on August 22, 2011, at 8:48:40
In reply to Re: Change in mood rhythm...SLS » B2chica, posted by SLS on August 15, 2011, at 17:18:23
Hi SLS.
one pdoc mentioned that i had been on TCA's with no luck...i assumed it was the trazadone and remeron.. i wonder if he was even looking at the right file?? he was a bit flighty so that does not surprise me a bit. so that's another story.if i'm on pristiq, perphenazine and adderall, gabapentin at nights for sleep/relax and day PRN for anxiety. which of the TCA's would you think work well for me.
my depression tends to cycle between aggitation/anxiety and lethargic hopeless/delusional depression. at its worst i do have some auditory/visual illusions.i am not really bad off. but im just not above water. i feel like im bobbing in the ocean, not quite able to stay above water.
which (if any) TCA could i augment with? i see pdoc this friday.
thank you so much for your help
> Neither one of these drugs is a TCA. Examples of TCA are: imipramine, desipramine, amitriptyline, nortriptyline, doxepin, trimipramine, protriptyline, amoxapine, and clomipramine.
>
> For depression, I prefer nortriptyline and desipramine because they have relatively mild side effects compared to the others. For OCD, clomipramine is the most effective. I am currently taking a combination of Nardil and nortriptyline.
>
>
> > should i try another TCA?
>
> You haven't tried one yet, I don't think. :-)
>
> > should i just jump in and try Maoi next...
>
> I don't know. What are the main symptoms of your illness?
>
> > i have always made the assumption that dopamine was my key.
>
> Can you detail for me the reasons you have for coming to this conclusion? It would be helpful.
>
>
> - Scott
Posted by SLS on August 22, 2011, at 10:22:55
In reply to Question TCA...SLS » SLS, posted by B2chica on August 22, 2011, at 8:48:40
> Hi SLS.
> one pdoc mentioned that i had been on TCA's with no luck...i assumed it was the trazadone and remeron.. i wonder if he was even looking at the right file?? he was a bit flighty so that does not surprise me a bit. so that's another story.
>
> if i'm on pristiq, perphenazine and adderall, gabapentin at nights for sleep/relax and day PRN for anxiety. which of the TCA's would you think work well for me.
> my depression tends to cycle between aggitation/anxiety and lethargic hopeless/delusional depression. at its worst i do have some auditory/visual illusions.
>
> i am not really bad off. but im just not above water. i feel like im bobbing in the ocean, not quite able to stay above water.
>
> which (if any) TCA could i augment with? i see pdoc this friday.
>
> thank you so much for your help
Hi B2C.I once had a partial response to a combination of Effexor and nortriptyline. Pristiq is a daughter drug to Effexor and has many of the same properties. I would recommend nortriptyline because it is relatively mild on side effects and the correct dosage can be determined by taking blood tests.
- Scott
Posted by B2chica on August 22, 2011, at 13:53:05
In reply to Re: Question TCA...SLS » B2chica, posted by SLS on August 22, 2011, at 10:22:55
This is the end of the thread.
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