![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 31. Go back in thread:
Posted by papillon2 on August 6, 2012, at 5:47:33
In reply to Re: To all treatment-resistant people!, posted by slabicki on August 5, 2012, at 21:00:06
Simplifying one's life is necessary. Stress avoidance. Trying to develop/retain good lifestyle factors: sleep, diet, exercise, relaxation. Keeping occupied but not too occupied - it's a delicate balance. CBT/DBT provides ways to cope/live with the illness even when it does not cause substantial symptom relief. Trying not to beat myself too much over the head when it is too hard to do these things.
There are a number of experimental treatments in the works. Things like ketamine, rTMS, the use of psychostimulants as adjuncts. Perhaps look into these?
I am treatment-resistant, but seemingly less so than you. I get a partial response to an ever dwindling number of medications, without which I am barely able to eat/drink/walk/communicate.
Posted by SLS on August 6, 2012, at 6:22:46
In reply to Re: To all treatment-resistant people! » slabicki, posted by papillon2 on August 6, 2012, at 5:47:33
> Simplifying one's life is necessary. Stress avoidance. Trying to develop/retain good lifestyle factors: sleep, diet, exercise, relaxation. Keeping occupied but not too occupied - it's a delicate balance. CBT/DBT provides ways to cope/live with the illness even when it does not cause substantial symptom relief. Trying not to beat myself too much over the head when it is too hard to do these things.
These things work for me, too.
> I get a partial response to an ever dwindling number of medications, without which I am barely able to eat/drink/walk/communicate.
Gosh. Join the club. :-(
- Scott
Posted by papillon2 on August 6, 2012, at 12:00:24
In reply to Re: To all treatment-resistant people! » slabicki, posted by papillon2 on August 6, 2012, at 5:47:33
> There are a number of experimental treatments in the works. Things like ketamine, rTMS, the use of psychostimulants as adjuncts. Perhaps look into these?
Sorry, I just read from your original post that you have already tried TMS.
I'm really just throwing things out there and hoping something sticks, but are there any meds you tried years ago (at least five, ten) which didn't do much at the time? Would you be willing to try them again?
I read a first-hand response from a guy who had run the gamut of different medications for depression, multiple meds in all the different classes, combinations with mood stabilizers, anti-psychotics, etc. Most had worked for a time before pooping out. ECT had worked well previously and he was considering another round.
His family doctor wanted him to do a trial of one of the more common SSRIs (Prozac or Zoloft, can't recall which) before having ECT and he thought he'd humor him since he had nothing to lose. He wasn't expecting anything though, as he'd had given it two separate trials a decade or more ago and it hadn't done anything at the time. Well... surprise! His depression went into remission.
I found this story extremely bizarre (my initial response being WTF?!) given that his depression was obviously severe enough to warrant ECT yet the 'big guns' of meds weren't helping. But hey, the brain is a mysterious organ, maybe the opposite of a 'poop out' can happen?
Anyway, just thought I'd mention it. Feel free to dismiss as wacky. I'm still not quite sure what to think about it.
Posted by alchemy on August 6, 2012, at 21:03:23
In reply to Re: To all treatment-resistant people!, posted by slabicki on August 5, 2012, at 21:00:06
> I'm just so scared that if I don't do something, I will stay like that and I will be disabled.
> I was on planning returning to work before that happened. I know that my symptoms will stay without medical intervention.
> I was going to ask the treatment-resistant people how do they handle day to day life.
> I'm past of trying different medication combinations.I'm so sorry for your situation. It is bringing tears to my eyes to know there is someone treatment resistant like me. I don't know if there has actually been any med that has really helped me, but there has been plenty that have made me worse. I am currently on medication. I guess I would say that the xanax xr actually helps me for some symptoms.
I have also had ECT rounds a few times. Two rounds were to help me from medication trials gone wrong & ECT was a miracle. After 6 treatments I had never felt so good in my life. Unfortunately it didn't last more than a couple weeks, but I was much better than before I had the treatments.
One time I was hit with anxiety from hell. It must have been because I went off meds for an Emsam trial and then went off Emsam. I went to the hospital, and the thought of ECT made my anxiety 10x worse. I only did a couple. Xanax was a better choice for me than ECT at that time.
My advice would be that you definitely need to do something medically. It's good to know that ECT has helped in the past, so that can help you decide. Can you hang in there for a while with some more drug trials or do you think the possible rapid effects of ECT are needed first? And then possibly maintenance ECT. Maintenance treatments works for a lot of people. As scary as it is, if it worked for me I would do it. But our situations, background, and reactions to drugs all differ.
I will be checking in to see how things are. Hang in there (and me too :))
Posted by Slabicki on August 6, 2012, at 21:09:19
In reply to Re: To all treatment-resistant people!, posted by papillon2 on August 6, 2012, at 12:00:24
> > There are a number of experimental treatments in the works. Things like ketamine, rTMS, the use of psychostimulants as adjuncts. Perhaps look into these?
>
> Sorry, I just read from your original post that you have already tried TMS.
>
> I'm really just throwing things out there and hoping something sticks, but are there any meds you tried years ago (at least five, ten) which didn't do much at the time? Would you be willing to try them again?
>
> I read a first-hand response from a guy who had run the gamut of different medications for depression, multiple meds in all the different classes, combinations with mood stabilizers, anti-psychotics, etc. Most had worked for a time before pooping out. ECT had worked well previously and he was considering another round.
>
> His family doctor wanted him to do a trial of one of the more common SSRIs (Prozac or Zoloft, can't recall which) before having ECT and he thought he'd humor him since he had nothing to lose. He wasn't expecting anything though, as he'd had given it two separate trials a decade or more ago and it hadn't done anything at the time. Well... surprise! His depression went into remission.
>
> I found this story extremely bizarre (my initial response being WTF?!) given that his depression was obviously severe enough to warrant ECT yet the 'big guns' of meds weren't helping. But hey, the brain is a mysterious organ, maybe the opposite of a 'poop out' can happen?
>
> Anyway, just thought I'd mention it. Feel free to dismiss as wacky. I'm still not quite sure what to think about it.Thank you for your ideas. I wish the pills would work, but they are just sugar pills for me.
I'm just in my desperate search now.
I've checked:
doxycyline - it causes depression
celebrex - causes depression
infliximab - too risky to try
Also - rapamycin, the studies were conducted just
on mice. I don't know what to think now - I will try anything and my wonderful Pdoc will prescribe it as a compassionate way just to try it.I haven't try Ketamine and GHB yet. My Pdoc was reluctant to prescibe GHB, and I don't think he will.
I've tried many off label meds in the past.Slabicki
Posted by Slabicki on August 6, 2012, at 21:26:14
In reply to Re: To all treatment-resistant people!, posted by alchemy on August 6, 2012, at 21:03:23
> > I'm just so scared that if I don't do something, I will stay like that and I will be disabled.
> > I was on planning returning to work before that happened. I know that my symptoms will stay without medical intervention.
> > I was going to ask the treatment-resistant people how do they handle day to day life.
> > I'm past of trying different medication combinations.
>
> I'm so sorry for your situation. It is bringing tears to my eyes to know there is someone treatment resistant like me. I don't know if there has actually been any med that has really helped me, but there has been plenty that have made me worse. I am currently on medication. I guess I would say that the xanax xr actually helps me for some symptoms.
>
> I have also had ECT rounds a few times. Two rounds were to help me from medication trials gone wrong & ECT was a miracle. After 6 treatments I had never felt so good in my life. Unfortunately it didn't last more than a couple weeks, but I was much better than before I had the treatments.
>
> One time I was hit with anxiety from hell. It must have been because I went off meds for an Emsam trial and then went off Emsam. I went to the hospital, and the thought of ECT made my anxiety 10x worse. I only did a couple. Xanax was a better choice for me than ECT at that time.
>
> My advice would be that you definitely need to do something medically. It's good to know that ECT has helped in the past, so that can help you decide. Can you hang in there for a while with some more drug trials or do you think the possible rapid effects of ECT are needed first? And then possibly maintenance ECT. Maintenance treatments works for a lot of people. As scary as it is, if it worked for me I would do it. But our situations, background, and reactions to drugs all differ.
>
> I will be checking in to see how things are. Hang in there (and me too :))Hi Alchemy,
Thank you for your support. That's good that you are on medication, at least something works.
That's really strange - why do we have anxiety of ECT if it worked before?
The anesthesia doesn't hurt, you just need to breathe. But still it's a horrifying experience.I will try meds that are in the trial now, if I can find any.
Thank you again for your response.Slabicki
Posted by alchemy on August 6, 2012, at 21:29:17
In reply to Re: Desperately looking for a novel med now! » papillon2, posted by Slabicki on August 6, 2012, at 21:09:19
> Thank you for your ideas. I wish the pills would work, but they are just sugar pills for me.
> I'm just in my desperate search now.
> I've checked:
> doxycyline - it causes depression
> celebrex - causes depression
> infliximab - too risky to try
> Also - rapamycin, the studies were conducted just
> on mice. I don't know what to think now - I will try anything and my wonderful Pdoc will prescribe it as a compassionate way just to try it.
>
> I haven't try Ketamine and GHB yet. My Pdoc was reluctant to prescibe GHB, and I don't think he will.
> I've tried many off label meds in the past.
>
> SlabickiDid your dr let you try the off label meds? I had to push mine to try one of the parkinson drugs. I'm pretty sure I am his most treatment resistant patient. He has hinted that I only need to learn how to cope with nothing really working.
I have read where people have learned to just "accept" their illness and work around it. I cannot live this way. It is non-relenting and has been haunting me for 30 years. Sorry my post isn't helpful right now. I am looking for the other responses as well. I guess I just keep painfully in the semi-survival mode. I'm not stuck in bed all of the time, sometimes I can put on the happy mask. I'm glad I at least live in an age where there are treatments, but I do not respond to them.
Posted by alchemy on August 6, 2012, at 21:35:26
In reply to Re: To all treatment-resistant people! » alchemy, posted by Slabicki on August 6, 2012, at 21:26:14
> Hi Alchemy,
>
> Thank you for your support. That's good that you are on medication, at least something works.
> That's really strange - why do we have anxiety of ECT if it worked before?
> The anesthesia doesn't hurt, you just need to breathe. But still it's a horrifying experience.
>
> I will try meds that are in the trial now, if I can find any.
> Thank you again for your response.
>
> SlabickiI don't know why we can have so much anxiety about a short dose of anesthesia when we know it is helpful. I don't care so much that they are shocking my brain - it needs to be shocked! Like you, it's the anesthesia & the oxygen.
We go to sleep every night into a different state of consciousness. I don't know why it freaks me out so much to go into a different state of consiousness with anesthesia. Even though I've done it before and had no negative effects from it. But the anxiety was extremely amplified when I was already suffering from anxiety.
Posted by Slabicki on August 6, 2012, at 21:36:25
In reply to Re: To all treatment-resistant people! » papillon2, posted by SLS on August 6, 2012, at 6:22:46
> > Simplifying one's life is necessary. Stress avoidance. Trying to develop/retain good lifestyle factors: sleep, diet, exercise, relaxation. Keeping occupied but not too occupied - it's a delicate balance. CBT/DBT provides ways to cope/live with the illness even when it does not cause substantial symptom relief. Trying not to beat myself too much over the head when it is too hard to do these things.
>
> These things work for me, too.
>
> > I get a partial response to an ever dwindling number of medications, without which I am barely able to eat/drink/walk/communicate.
>
> Gosh. Join the club. :-(
>
>
> - ScottScott, how are you doing?
I just want to say Hi!
I remember you from over 5 years ago.
I think it's amazing that meds combinations still
work for you because I know you are treatment resistant. Good luck to you.Slabicki
Posted by Slabicki on August 6, 2012, at 21:49:50
In reply to Re: To all treatment-resistant people!, posted by alchemy on August 6, 2012, at 21:35:26
> > Hi Alchemy,
> >
> > Thank you for your support. That's good that you are on medication, at least something works.
> > That's really strange - why do we have anxiety of ECT if it worked before?
> > The anesthesia doesn't hurt, you just need to breathe. But still it's a horrifying experience.
> >
> > I will try meds that are in the trial now, if I can find any.
> > Thank you again for your response.
> >
> > Slabicki
>
> I don't know why we can have so much anxiety about a short dose of anesthesia when we know it is helpful. I don't care so much that they are shocking my brain - it needs to be shocked! Like you, it's the anesthesia & the oxygen.
> We go to sleep every night into a different state of consciousness. I don't know why it freaks me out so much to go into a different state of consiousness with anesthesia. Even though I've done it before and had no negative effects from it. But the anxiety was extremely amplified when I was already suffering from anxiety.Yes, I understand exactly what you mean.
But just a thought of it freaks me out right now.But ECT is a life saver, so I just want to encourage everyone who wants to change his life.
It changed mine years ago.
But of course everyone is different.
I thought I will never be able to function without
medications, but I did.Slabicki
Posted by Slabicki on August 6, 2012, at 21:56:47
In reply to Re: Desperately looking for a novel med now! » Slabicki, posted by alchemy on August 6, 2012, at 21:29:17
> > Thank you for your ideas. I wish the pills would work, but they are just sugar pills for me.
> > I'm just in my desperate search now.
> > I've checked:
> > doxycyline - it causes depression
> > celebrex - causes depression
> > infliximab - too risky to try
> > Also - rapamycin, the studies were conducted just
> > on mice. I don't know what to think now - I will try anything and my wonderful Pdoc will prescribe it as a compassionate way just to try it.
> >
> > I haven't try Ketamine and GHB yet. My Pdoc was reluctant to prescibe GHB, and I don't think he will.
> > I've tried many off label meds in the past.
> >
> > Slabicki
>
> Did your dr let you try the off label meds? I had to push mine to try one of the parkinson drugs. I'm pretty sure I am his most treatment resistant patient. He has hinted that I only need to learn how to cope with nothing really working.
>
> I have read where people have learned to just "accept" their illness and work around it. I cannot live this way. It is non-relenting and has been haunting me for 30 years. Sorry my post isn't helpful right now. I am looking for the other responses as well. I guess I just keep painfully in the semi-survival mode. I'm not stuck in bed all of the time, sometimes I can put on the happy mask. I'm glad I at least live in an age where there are treatments, but I do not respond to them.
>
>
> Yes, I have very compassionate Pdoc.
And I don't want to accept my illness - I'm
a fighter. We got to have hope!Slabicki
>
Posted by Slabicki on August 6, 2012, at 22:06:34
In reply to Re: Desperately looking for a novel med now! » alchemy, posted by Slabicki on August 6, 2012, at 21:56:47
> > > Thank you for your ideas. I wish the pills would work, but they are just sugar pills for me.
> > > I'm just in my desperate search now.
> > > I've checked:
> > > doxycyline - it causes depression
> > > celebrex - causes depression
> > > infliximab - too risky to try
> > > Also - rapamycin, the studies were conducted just
> > > on mice. I don't know what to think now - I will try anything and my wonderful Pdoc will prescribe it as a compassionate way just to try it.
> > >
> > > I haven't try Ketamine and GHB yet. My Pdoc was reluctant to prescibe GHB, and I don't think he will.
> > > I've tried many off label meds in the past.
> > >
> > > Slabicki
> >
> > Did your dr let you try the off label meds? I had to push mine to try one of the parkinson drugs. I'm pretty sure I am his most treatment resistant patient. He has hinted that I only need to learn how to cope with nothing really working.
> >
> > I have read where people have learned to just "accept" their illness and work around it. I cannot live this way. It is non-relenting and has been haunting me for 30 years. Sorry my post isn't helpful right now. I am looking for the other responses as well. I guess I just keep painfully in the semi-survival mode. I'm not stuck in bed all of the time, sometimes I can put on the happy mask. I'm glad I at least live in an age where there are treatments, but I do not respond to them.
> >
> >
> > Yes, I have very compassionate Pdoc.
> And I don't want to accept my illness - I'm
> a fighter. We got to have hope!
>
> Slabicki
> >
>
> So what do you think about Rapamycin?
I just want to break the cycle of depression.
It was the only choice I was able to find
(exept Ketamine and GHB)Slabicki
Posted by SLS on August 7, 2012, at 7:23:29
In reply to Re: To all treatment-resistant people!, posted by Slabicki on August 6, 2012, at 21:36:25
> > > I get a partial response to an ever dwindling number of medications, without which I am barely able to eat/drink/walk/communicate.
> > Gosh. Join the club. :-(> Scott, how are you doing?
I am frustrated, but grateful that I am getting a partial response for having added prazosin (Minipress) to my treatment regime. My goal is to return to work. I am still more depressed than I am well. I think I could work with a 50% improvement. My energy level is still too low, and I still have cognitive impairments that get in the way of reading, learning, and remembering.
My doctor chose prazosin for me based upon his thoughts regarding "developmental PTSD". Since prazosin is of help to people with adult PTSD (acute event driven), he thought that it might help me based upon my childhood history of chronic physical and emotional traumas combined with neglect.
http://www.positivehumandevelopment.com/developmental-ptsd.html
I recently tried adding Topamax, another drug that has been shown to help with PTSD. It made my condition significantly worse. I am looking to accelerate my rate of recovery. Prazosin just isn't working fast enough for me. I began taking it in December, 2011. I am certainly better on it than off it.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 4 mgThe one drug that I would like to jettison is Abilify. It raises my triglycerides to an unhealthy level (> 400). I might consider trying to discontinue it if I respond robustly to the addition of another drug. I might be able to do without lithium, but I keep it in place because it seems to reduce the risk of developing Alzheimer's Dementia. Unfortunately, depressive disorders increase this risk. I am hoping that lithium offsets this. In addition, lithium might accelerate the recovery of the hippocampus that occurs with successful treatment.
I am looking at trying rTMS or a method of reducing glutamatergic activity. Ketamine and memantine are examples of this. In addition, N-acetylcysteine (NAC), is of interest. Beyond these treatments, I have just about run out of ideas. Hopefully, I won't need any.
I may switch from prazosin to its sister drug, doxazosin. Doxazosin has a half-life of 22 hours. Prazosin is perhaps too short-acting, having a half-life of only 3 hours. I would like to see how I respond to a more consistent blood level of a NE alpha-1 antagonist. Of course, the possibility exists that prazosin does other things pharmacologically that doxazosin does not. I might not respond to doxazosin at all.
- Scott
Posted by phidippus on August 7, 2012, at 20:28:29
In reply to ketoconazole, ECT and I just need a support, posted by slabicki on August 3, 2012, at 18:51:09
The effects should have a gone away from the ketoconazole. How long have you been depressed now?
Eric
Posted by Slabicki on August 7, 2012, at 21:09:53
In reply to Re: ketoconazole, ECT and I just need a support » slabicki, posted by phidippus on August 7, 2012, at 20:28:29
> The effects should have a gone away from the ketoconazole. How long have you been depressed now?
>
> EricHi Eric,
Unfortunately the effects stayed with me for over a month. It looks like I developed the rapid cycling, exept there is no hypomania involved,
just switching in different levels of depression.
It's definitely a result of Ketaconazole, and I never experienced that before.
I wish I have never taken Ketaconazole,
but it's too late now.
It's a chemical imbalance and it won't go away, no matter what I do.
My methods of fighting depression like talking to people or physical activity don't work.
I need a medical intervention to beat the symptoms,
and there is no much options left.Slabicki
Posted by papillon2 on August 7, 2012, at 21:10:26
In reply to Re: ketoconazole, ECT and I just need a support » slabicki, posted by phidippus on August 7, 2012, at 20:28:29
If I were in your position I'd be seriously considering ketamine.
Posted by phidippus on August 7, 2012, at 21:28:56
In reply to Re: ketoconazole, ECT and I just need a support » phidippus, posted by Slabicki on August 7, 2012, at 21:09:53
ECT might be your best recourse, if you don't respond to medications.
Eric
Posted by SLS on August 8, 2012, at 1:02:20
In reply to Re: ketoconazole, ECT and I just need a support » phidippus, posted by Slabicki on August 7, 2012, at 21:09:53
Out of curiosity, how did you respond to the following:
1. Lamictal
2. Abilify
3. Wellbutrin
4. Paxil
5. Parnate
6. methylphenidate
7. Mirapex or RequipI'm sorry that you had such a miserable experience with ketoconazole. I had no luck with a drug that manipulates the cortisol (HPA) axis. Mifepristone made me feel strangely "washed out" by the end of the 8 day treatment period. It did not help at all. I had thought to try ketoconazole. I don't recall why I ultimately rejected the idea. I have had several drugs make me feel worse in ways that persisted for quite awhile after their discontinuation. Hopefully, you won't have to suffer that much longer.
I had some luck with the combination of nortriptyline + Effexor. It didn't provide as robust a response as I needed, but the improvement was persistent.
- Scott
Posted by Slabicki on August 9, 2012, at 22:49:36
In reply to Re: ketoconazole, ECT and I just need a support » Slabicki, posted by SLS on August 8, 2012, at 1:02:20
> Out of curiosity, how did you respond to the following:
Hi Scott, I've tried them all in the 90ties, when I was still responding to meds.
>
> 1. Lamictal
- it didn't work
> 2. Abilify
- I was already resistant to meds when I tried it,
so I had no response at all> 3. Wellbutrin
- my best medication, I had immediate response,
unfortunately it pooped out after a while
> 4. Paxil
- it was a horrible drug, I didn't feel good,
and I gained a lot of weight in just 3 months
> 5. Parnate
- I was already resistant when I tried it, it was
too stimulating for me and it lasted only 3 days
> 6. methylphenidate
- I responded but I developed the tolerance very quicky
> 7. Mirapex or Requip
- it was my miracle response, but it lasted a short time onlyScott, you must remember me maybe, it was 12 years ago (I can't believe it it was that long)
I was posting under AnnaP. and fighting with my
anergic depression.
I had ECT around 2003 and I returned to work, and I worked for 4 years without any medications.
ECT sort off cut my dependence on medications that
stopped working totally.
I thought I will never be able to function without
meds. So that's my story.By the way, have you ever tried Sulpiride?
Great medication and had no side effects for me.>
> I'm sorry that you had such a miserable experience with ketoconazole. I had no luck with a drug that manipulates the cortisol (HPA) axis. Mifepristone made me feel strangely "washed out" by the end of the 8 day treatment period. It did not help at all. I had thought to try ketoconazole. I don't recall why I ultimately rejected the idea. I have had several drugs make me feel worse in ways that persisted for quite awhile after their discontinuation. Hopefully, you won't have to suffer that much longer.
>
> I had some luck with the combination of nortriptyline + Effexor. It didn't provide as robust a response as I needed, but the improvement was persistent.
>
>
> - ScottThank you Scott for your post. I hope you feel
better.Slabicki
Posted by SLS on August 10, 2012, at 8:03:32
In reply to Re: ketoconazole, ECT and I just need a support » SLS, posted by Slabicki on August 9, 2012, at 22:49:36
Hi Slabicki.
I'm a little surprised that you didn't respond at all to Lamictal, even transiently. My initial thoughts were that dopaminergic (DA) drugs might help you. I see that some of your responses to various drugs are consistent with this idea. That doesn't guarantee that you will ultimately respond to a dopaminergic drug, but it is interesting.
Some people continue taking, or begin taking, medication after successful ECT. They believe that it has prevented relapse. A drug doesn't have to act directly on dopamine neurons to produce an increase in dopaminergic activity. Prozac is an example of a drug that can increase DA in important areas of the brain (prefrontal cortex) by modulating serotonin activity somewhere else upstream.
You might consider combining drugs. Wellbutrin + Effexor might be worth considering along with adding low-dosage lithium. It is too bad that you had a difficult time with Parnate. Perhaps Nardil would be easier for you to tolerate. It is less amphetamine-like than Parnate. It can be combined with Wellbutrin. I would also consider trying, Wellbutrin + Lamictal + Abilify if DA is to be a target.
My guess is that there are quite a few drug combinations treatments yet for you to try. I hope it doesn't take that long to find one that works.
> Thank you Scott for your post. I hope you feel
better.I am doing better than I was 10 years ago. I recently added a drug that modulates norepinephrine (NE) activity - prazosin. Prazosin is now being used to treat PTSD, but it might have other applications in psychiatry. I am still not ready to go back to work, though. I may have no choice but to remain patient and allow the antidepressant response to grow over time. However, I am looking at the glutamate system as another angle of attack to accelerate my recovery. Lamictal reduces glutamate activity. I am hoping to potentiate its anti-glutamatergic activity with drugs like memantine, ketamine - or even N-acetylcysteine (NAC). I will note here that a single molecule will often have multiple diverse properties that can be useful to treat unrelated illnesses. Amantadine is an example of this. It exerts both antiviral and and anti-parkinsons effects. Amantadine has even been used as and antidepressant. Some synthetic tetracycline antibiotics are capable of reducing inflammation in the brain through mechanism unrelated to its antimicrobial effects. Brain inflammation is associated with mood illness, although it might not be the direct cause of it.
Here is my current treatment regime:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 12 mgThis looks like a lot of drugs. I have tried to remove each one of them with the exception of lithium. I always relapse. If there were a single molecule that contained all of the drug mechanisms to be found in this combination, that would be fine. Personally, I don't care very much what my treatment looks like to other people or how the job gets done. I consider this to be rational polypharmacy.
- Scott
Posted by Slabicki on August 11, 2012, at 14:59:37
In reply to Re: ketoconazole, ECT and I just need a support » Slabicki, posted by SLS on August 10, 2012, at 8:03:32
Hi Scott,
I appreciate your support, but meds are not the option for me anymore. They stopped working over 10 years ago. I've tried different combinations when they were still partially working.
But with time I've developed the total tolerance to them, it's like a brain desensitization or something.
It's also my fault, because when I was on Zoloft,
I stopped and restarted it a few times. I didn't know you can't really do that at that time.Anyway, I'm glad to hear that you are feeling better and meds are still working for you.
You even said that you feel better than 10 years ago. And that's good you have benefitted from Prazosin.So you are able to function o'right right now?
How is your daily life if you don't mind sharing?Slabicki
Posted by SLS on August 11, 2012, at 16:16:39
In reply to Re: ketoconazole, ECT and I just need a support » SLS, posted by Slabicki on August 11, 2012, at 14:59:37
> I appreciate your support, but meds are not the option for me anymore. They stopped working over 10 years ago. I've tried different combinations when they were still partially working.
Ouch. Sorry.
> But with time I've developed the total tolerance to them, it's like a brain desensitization or something.
Yes. That's a good way of looking at what must be some sort of set of persistent compensatory mechanisms that affect drug response. Perhaps this involves changes in the disposition of gene expression. I have also experienced an increased resistence to treatment over the years that are certainly the result of multiple drug exposures. There is also a phenomenon known as "cross-tolerance". Some people respond amazingly well to the SSRI, Paxil, when it is used as a first-line treatment. However, it often poops-out after a few years as tolerance develops. Unfortunately, many people find that they have become tolerant and unresponsive to all SSRIs as the result of this single exposure to Paxil.
> It's also my fault, because when I was on Zoloft,
> I stopped and restarted it a few times.Yes. This is a common story. 20-20 hindsight is difficult to reconcile.
> I didn't know you can't really do that at that time.
No one did. You are not to blame.
> Anyway, I'm glad to hear that you are feeling better and meds are still working for you.
Thanks.
> You even said that you feel better than 10 years ago. And that's good you have benefitted from Prazosin.
I was very surprised that I responded so well to prazosin. It was my doctor's choice that I gave no chance of working. I took it just to humor him.
> So you are able to function o'right right now?
I have not reached a 50% improvement at this point. I'm not convinced that I have plateaued yet. This is a good thing. Despite this, I am still looking to accelerate my rate of recovery. I would like to return to work by next year. I can't do that now. I still have deficits of energy, reading, learning, and remembering. I tried working for a major retail store. I failed to perform on my very first day when I was unable to read and learn during an online training course. I failed the test. I had to leave.
> How is your daily life if you don't mind sharing?
I am able to live independently. I can now leave the house and perform more than one or two tasks per day. Shopping for groceries is no longer a daunting task, and I am able to keep up with paying my bills. I am going out and socializing. I even managed to get myself to sing at a karaoke bar. Reading is easier, and I can get through a few paragraphs before having to stop. My Scientific American subscription is not a total waste of money anymore. I am hoping that I can discipline myself to resume physical exercise soon.
If I do eventually attain remission after having become so tolerant and non-responsive to most drug treatments, how can one be so certain that they cannot match this feat? Obviously, I have no knowledge of your treatment history. I would just hope that there are treatments that you have not yet tried. Perhaps this is not the time for you to pursue them. I encourage you to keep an open mind to all treatment options.
What non-pharmacological treatments are you considering?
ECT
rTMS
tDCS
MST
VNS
DBS
MRI
CBT
DBT
IPTI can't think of any more acronyms right now.
:-)
- Scott
Posted by Slabicki on August 11, 2012, at 18:27:49
In reply to Re: ketoconazole, ECT and I just need a support » Slabicki, posted by SLS on August 11, 2012, at 16:16:39
ECT is the only option.
I've already tried rTMS with no results.
Ketamine may be an option to try.
Xyrem is another option, but I've read it can
cause depression.I'm just curious, how is Prazosin helping you?
I've read it's not indicated really for depression.Have you tried Valdoxan?
Slabicki
Posted by AlexCanada on August 11, 2012, at 22:46:26
In reply to Re: To all treatment-resistant people! » slabicki, posted by papillon2 on August 6, 2012, at 5:47:33
I am very similar in my symptoms. I would not be able to type this msg without medication. I would an emtpy lifeless, severely cognitively impaired, non social, zombie whom is unable to enjoy anything. Motivation to shower would even be difficult and I'd have to push myself to do everything.
Ritalin, Valium, Parnate have helped me all to a degree but parnate has lot so much of it's effect. Rhodiola Rosia helped tremendously cognitively, slightly for mood, and quite a bit for motivation.
Papillon... what meds have helped you the most? Please let me know. I am becoming desperate at times because I know that I may have to drop this parnate soon. It doesn't help the way it did years ago! rTMS I was involved in a 4 week trail. It did nothing for me that I could tell but suppossedly is successful for various patients (the hype states at least). I'm not sure but rTMS may have negatively impacted my horrendous memory problems further. I have Antero Grade Memory Loss... difficulty retaining new information. If I ever even feel like watching a movie (rare) I will forget most of it the next day. Only some miniscule details are ever able to stick. And if it's a year later then it's as if I'm watching the same movie yet... it feels ''fresh'' yet deja vu.
I hate living day to day like this. I have to take notes on everything or I'd be lost.
> Simplifying one's life is necessary. Stress avoidance. Trying to develop/retain good lifestyle factors: sleep, diet, exercise, relaxation. Keeping occupied but not too occupied - it's a delicate balance. CBT/DBT provides ways to cope/live with the illness even when it does not cause substantial symptom relief. Trying not to beat myself too much over the head when it is too hard to do these things.
>
> There are a number of experimental treatments in the works. Things like ketamine, rTMS, the use of psychostimulants as adjuncts. Perhaps look into these?
>
> I am treatment-resistant, but seemingly less so than you. I get a partial response to an ever dwindling number of medications, without which I am barely able to eat/drink/walk/communicate.
Posted by SLS on August 12, 2012, at 7:08:26
In reply to Melancholic Depression... Over 10 years..., posted by AlexCanada on August 11, 2012, at 22:46:26
> I am very similar in my symptoms. I would not be able to type this msg without medication.
That is pretty bad. I managed to type messages when I was feeling worse, but each message would take a long time to compose - often over an hour. Things like that can remain hidden from everyone else. It is hard to see the amount of internal "push" it takes for someone else to function. I would often sit at my computer with my fingers on the keyboard, staring at the monitor with eyes unfocused, and typing nothing. Those were not fun times.
> I would an emtpy lifeless, severely cognitively impaired, non social, zombie whom is unable to enjoy anything. Motivation to shower would even be difficult and I'd have to push myself to do everything.
That is horrendous. I would like to say that it is hard to believe that you manage to fight your illness and continue to have hope in such a severely depressive state. Unfortunately, it is easy to believe. So many people on Psycho-Babble have been smited to live similar lives. You have already accomplished more than what many healthy people have. You have chosen to remain alive and managed to survive while trapped in an altered state that leaves you functioning at a level that is subhuman.
> Ritalin, Valium, Parnate have helped me all to a degree but parnate has lot so much of it's effect. Rhodiola Rosia helped tremendously cognitively, slightly for mood, and quite a bit for motivation.
How high a dosage of Parnate have you tried?
I have found that I respond better to Parnate when it is combined with nortriptyline and lithium. The only time I experienced full remission was when I was treated with Parnate + desipramine. I relapsed when this treatment was discontinued by my doctor, but never responded well to it again. I had a very short, but robust response to Nardil. Have you already tried it?
I have recently added prazosin to my treatment regime with fair results. I also take Parnate, nortriptyline, Lamictal, lithium, and Abilify.
I have thought to try Rhodiola Rosia, but have had a few other things I wanted to try first. A poster here, Bleauberry, has been touting its antidepressant and anxiolytic properties for quite awhile. How much do you take? I would welcome an improvement in cognitive function. I'm sure you know how depression can destroy one's ability to read, learn, and remember. Low energy and cognitive impairments are what prevents me from working. My quality of life would still be limited by anhedonia and the lack of interest and motivation along with flat affect, but at least I would be out of the house and functioning in society.
Good luck in finding an effective treatment.
- Scott
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