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Dr. Bob is Robert Hsiung, MD,
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Posted by chicagokat on September 10, 2012, at 10:42:19
Hi all,
I suffer from treatment-resistant depression and I see my pdoc tomorrow afternoon and I am searching for ideas to suggest to him. I have tried all the basic things, and they've all either stopped working for me or had intolerable side effects. This includes:
SSRIs
SNRIs
TCAz
Atypical antipsychotics
Mood stabilizers (lithium, lamictal)
MAOIs (ensam, Nardil Marplan) I should mention that Nardil worked GREAT for my depression and anxietty, but at doses above 45mg it gave me ataxia and I suffered falls...and NO, this was not due to orthostatic hypotension)
and atypical antidepressants like trazodone and remeron.
I've also tried ECT, which only made me feel worse.Right now I'm on Ritalin, and it, too, is giving out on me; I was gonna see how tomorrow goes then give the Ritalin a holiday to see if it will work for me again. I'm aalso on Lyrica for anxiety,, for which it works, but it seems to worsen my depression.
I was thinking of going back on Lexapro; I was on it last spring, but stopped b/c it wasn't helping my depression, but it occurred to me that it may well have been helping my anxiety, which has come back in force since I stopped the Lexapro.So does anyone have any other ideas? I've given my pdoc info on Tramadol, but he seems very hesitant to prescribe it.
Thanks for any ideas,
Kat
Posted by Lou Pilder on September 10, 2012, at 11:10:42
In reply to Need out of the box suggestions, posted by chicagokat on September 10, 2012, at 10:42:19
> Hi all,
> I suffer from treatment-resistant depression and I see my pdoc tomorrow afternoon and I am searching for ideas to suggest to him. I have tried all the basic things, and they've all either stopped working for me or had intolerable side effects. This includes:
> SSRIs
> SNRIs
> TCAz
> Atypical antipsychotics
> Mood stabilizers (lithium, lamictal)
> MAOIs (ensam, Nardil Marplan) I should mention that Nardil worked GREAT for my depression and anxietty, but at doses above 45mg it gave me ataxia and I suffered falls...and NO, this was not due to orthostatic hypotension)
> and atypical antidepressants like trazodone and remeron.
> I've also tried ECT, which only made me feel worse.
>
> Right now I'm on Ritalin, and it, too, is giving out on me; I was gonna see how tomorrow goes then give the Ritalin a holiday to see if it will work for me again. I'm aalso on Lyrica for anxiety,, for which it works, but it seems to worsen my depression.
> I was thinking of going back on Lexapro; I was on it last spring, but stopped b/c it wasn't helping my depression, but it occurred to me that it may well have been helping my anxiety, which has come back in force since I stopped the Lexapro.
>
> So does anyone have any other ideas? I've given my pdoc info on Tramadol, but he seems very hesitant to prescribe it.
>
> Thanks for any ideas,
> KatKat,
You wrote,[...I am searching for ideas to suggest to him (the psychiatrist)..intolerable side effects... does anyone have any other ideas?...Thanks for any ideas...].
Posted by SLS on September 10, 2012, at 11:45:37
In reply to Need out of the box suggestions, posted by chicagokat on September 10, 2012, at 10:42:19
Where is Wellbutrin?
Have you ever tried Lamictal?
- Scott
Posted by Phillipa on September 10, 2012, at 12:09:19
In reply to Re: Need out of the box suggestions » chicagokat, posted by SLS on September 10, 2012, at 11:45:37
Luvox? It did work once well for me at high dose? Phillipa
Posted by zazenducke on September 10, 2012, at 13:03:52
In reply to Re: Need out of the box suggestions » chicagokat, posted by SLS on September 10, 2012, at 11:45:37
> Where is Wellbutrin?
>
> Have you ever tried Lamictal?
>SNRIs
TCAz
Atypical antipsychotics
Mood stabilizers (lithium, lamictal)
See original post above Mr SNever take advice from strangers on the internet :)
Posted by chicagokat on September 10, 2012, at 13:22:52
In reply to Re: Need out of the box suggestions » chicagokat, posted by SLS on September 10, 2012, at 11:45:37
> Where is Wellbutrin?
>
> Have you ever tried Lamictal?
>
>
> - ScottSorry Scott, I've been on so many drugs, I forgot to mention that I've tried Wellbutrin - 3x, and it has always caused bad anxiety for me. And yes, I've tried Lamictal.
Posted by chicagokat on September 10, 2012, at 13:25:03
In reply to Re: Need out of the box suggestions, posted by Phillipa on September 10, 2012, at 12:09:19
> Luvox? It did work once well for me at high dose? Phillipa
Hi Phillipa, how are you?I've wanted to try Luvox, but my insurance doesn't cover it, and it's like 400-some dollars out of pocket! Thanks for the suggestion, though
Posted by phidippus on September 10, 2012, at 13:49:21
In reply to Need out of the box suggestions, posted by chicagokat on September 10, 2012, at 10:42:19
Tramadol works very well for treating depression. However, I recommend it be taken with another antidepressant.
Why not continue the Nardil at a 40 mg dose? You don't need to max it out and incur ataxia.
I don't think these medications stop working for you. Its more likely your depression and anxiety worsen. Which of the SSRIs have you tried? Which of the SNRIs? TCAs? Did you give these medications 8 weeks to work? Have you tried antidepressant combinations? Did you take the antipsychotics with an antidepressant?
Have you tried Deplin?
Eric
Posted by SLS on September 10, 2012, at 14:40:53
In reply to Re: Need out of the box suggestions » SLS, posted by zazenducke on September 10, 2012, at 13:03:52
> > Where is Wellbutrin?
>
>
>
> >
> > Have you ever tried Lamictal?
> >
>
> SNRIs
> TCAz
> Atypical antipsychotics
> Mood stabilizers (lithium, lamictal)
>
>
> See original post above Mr S
>
> Never take advice from strangers on the internet :)
You should really find a hobby.
- Scott
Posted by chicagokat on September 10, 2012, at 14:55:58
In reply to Re: Need out of the box suggestions » chicagokat, posted by phidippus on September 10, 2012, at 13:49:21
> Tramadol works very well for treating depression. However, I recommend it be taken with another antidepressant.
>
> Why not continue the Nardil at a 40 mg dose? You don't need to max it out and incur ataxia.
>
> I don't think these medications stop working for you. Its more likely your depression and anxiety worsen. Which of the SSRIs have you tried? Which of the SNRIs? TCAs? Did you give these medications 8 weeks to work? Have you tried antidepressant combinations? Did you take the antipsychotics with an antidepressant?
>
> Have you tried Deplin?
>
> Eric
>I was on Prozac for years, Zoloft for months, Paxil for years, Lexapro for many years. We maxed out the doses of each. As you suggest, my depression and anxieety prob. just got worse, b/c they all stopped working. Same with Effexor and Pristiq. Cymbalta made me nuts, I couldn't tolerate it. And yes, tried atypical andtipsychotics with SSRIs...the only one I could really tolerate was Zyprexa, the others gave me akathisia. Zyprexa augmentation worked for a while, but then it, too, gave me akathisia. Seems all this happened after I had ECT. I swear, it not only didn't work, but made my depression, and especially my anxiety, much worse.
Oh, as far as TCAs, I've tried Desipramine and Amitryptiline, both for over 8 weeks, to no avail.
And yes, I've tried Deplin.I have considered going back on the Nardil at the low dose of 45mg. I know from history that that dose definitely would wipe out my anxiety, and would probably help with my depression, but it may take a while for that.
Thanks for your ideas Eric, I appreciate them.
Posted by SLS on September 10, 2012, at 15:16:08
In reply to Re: Need out of the box suggestions » SLS, posted by chicagokat on September 10, 2012, at 13:22:52
> > Where is Wellbutrin?
> >
> > Have you ever tried Lamictal?
> >
> >
> > - Scott
>
> Sorry Scott, I've been on so many drugs, I forgot to mention that I've tried Wellbutrin - 3x, and it has always caused bad anxiety for me.Ouch.
For me, Wellbutrin made me more depressed with dysphoria and decreased energy. It was not at all activating or anxiogenic. More people react to Wellbutrin as you have. I think I tried it three or four times.
> And yes, I've tried Lamictal.
Sorry. Sometimes I miss a word or two. I need to testify that I am indeed human - and a rather fallible one at that (as is often pointed out by some).
Phiddipus has some interesting ideas.
I don't know what the ataxia with Nardil is all about. Ataxia is listed as a rare side effect. (Isn't it nice to be special)? I guess anything is possible when it comes to the brain. It's too bad that it wasn't as simple as low blood pressure. Have you ever had any problems with motion sickness? Are you taking other drugs besides psychotropics? Make sure you are not taking diphenhydramine. Nardil has been known to interact badly with some drugs to produce ataxia - even tryptophan.
I hope you continue your dialogue here. I'm sure you will receive some ideas that are "outside the box".
- Scott
Posted by SLS on September 10, 2012, at 15:45:36
In reply to Need out of the box suggestions, posted by chicagokat on September 10, 2012, at 10:42:19
> I don't know what the ataxia with Nardil is all about. Ataxia is listed as a rare side effect. (Isn't it nice to be special)? I guess anything is possible when it comes to the brain. It's too bad that it wasn't as simple as low blood pressure. Have you ever had any problems with motion sickness? Are you taking other drugs besides psychotropics? Make sure you are not taking diphenhydramine. Nardil has been known to interact badly with some drugs to produce ataxia - even tryptophan.
>
> I hope you continue your dialogue here. I'm sure you will receive some ideas that are "outside the box".
The thought occurred to me that hydroxyzine could treat both anxiety and ataxia if the ataxia is similar to motion sickness. I don't think there is a contraindication for taking hydroxyzine and Nardil together.
- Scott
Posted by chicagokat on September 10, 2012, at 15:54:56
In reply to Re: Need out of the box suggestions » chicagokat, posted by SLS on September 10, 2012, at 15:16:08
> > > Where is Wellbutrin?
> > >
> > > Have you ever tried Lamictal?
> > >
> > >
> > > - Scott
> >
> > Sorry Scott, I've been on so many drugs, I forgot to mention that I've tried Wellbutrin - 3x, and it has always caused bad anxiety for me.
>
> Ouch.
>
> For me, Wellbutrin made me more depressed with dysphoria and decreased energy. It was not at all activating or anxiogenic. More people react to Wellbutrin as you have. I think I tried it three or four times.
>
> > And yes, I've tried Lamictal.
>
> Sorry. Sometimes I miss a word or two. I need to testify that I am indeed human - and a rather fallible one at that (as is often pointed out by some).
>
> Phiddipus has some interesting ideas.
>
> I don't know what the ataxia with Nardil is all about. Ataxia is listed as a rare side effect. (Isn't it nice to be special)? I guess anything is possible when it comes to the brain. It's too bad that it wasn't as simple as low blood pressure. Have you ever had any problems with motion sickness? Are you taking other drugs besides psychotropics? Make sure you are not taking diphenhydramine. Nardil has been known to interact badly with some drugs to produce ataxia - even tryptophan.
>
> I hope you continue your dialogue here. I'm sure you will receive some ideas that are "outside the box".
>
>
> - ScottLOL Scott, no biggie. I'm glad you're in on this discussion b/c I find your responses intelligent and informative. :)
Nope, don't suffer from motion sickness in the least. Though I do admit to being inherently uncoordinated. Haven't been able to balance myself while standing on one foot ever since I was a young child. So maybe that makes me more apt to develop ataxia. Besides, me and my pdoc call me Side Effect Girl lol
I wasn't taking any other drugs while on Nardill, except Ambien...maybe it contributed to ataxia?
Posted by chicagokat on September 10, 2012, at 15:58:58
In reply to Re: Need out of the box suggestions » chicagokat, posted by SLS on September 10, 2012, at 15:45:36
> > I don't know what the ataxia with Nardil is all about. Ataxia is listed as a rare side effect. (Isn't it nice to be special)? I guess anything is possible when it comes to the brain. It's too bad that it wasn't as simple as low blood pressure. Have you ever had any problems with motion sickness? Are you taking other drugs besides psychotropics? Make sure you are not taking diphenhydramine. Nardil has been known to interact badly with some drugs to produce ataxia - even tryptophan.
> >
> > I hope you continue your dialogue here. I'm sure you will receive some ideas that are "outside the box".
>
>
> The thought occurred to me that hydroxyzine could treat both anxiety and ataxia if the ataxia is similar to motion sickness. I don't think there is a contraindication for taking hydroxyzine and Nardil together.
>
>
> - ScottI'll ask my pdoc about hydroxyzine, but you do know it's an anti-histamine just like Benadry is?
My pdoc had said that the only thing that *might* help is propranolol, but of course a high dose of that would make me more depressed.
Heck, I'm ready to tell him I'll get a walker and wear a ****ing helmet if it means I can get back on Nardil, it helped do damn much!
Posted by SLS on September 10, 2012, at 17:36:41
In reply to Re: Need out of the box suggestions » SLS, posted by chicagokat on September 10, 2012, at 15:58:58
> > > I don't know what the ataxia with Nardil is all about. Ataxia is listed as a rare side effect. (Isn't it nice to be special)? I guess anything is possible when it comes to the brain. It's too bad that it wasn't as simple as low blood pressure. Have you ever had any problems with motion sickness? Are you taking other drugs besides psychotropics? Make sure you are not taking diphenhydramine. Nardil has been known to interact badly with some drugs to produce ataxia - even tryptophan.
> > >
> > > I hope you continue your dialogue here. I'm sure you will receive some ideas that are "outside the box".> > The thought occurred to me that hydroxyzine could treat both anxiety and ataxia if the ataxia is similar to motion sickness. I don't think there is a contraindication for taking hydroxyzine and Nardil together.
> I'll ask my pdoc about hydroxyzine, but you do know it's an anti-histamine just like Benadry is?Benadryl is different in that is acts a bit like an SSRI. SSRIs and SNRIs don't get along well with MAOIs.
> My pdoc had said that the only thing that *might* help is propranolol, but of course a high dose of that would make me more depressed.
Not always.
> Heck, I'm ready to tell him I'll get a walker and wear a ****ing helmet if it means I can get back on Nardil, it helped do damn much!
I think it makes sense to search aggressively for a treatment for the ataxia so that you can continue taking Nardil. Maybe your doctor has some neurologist friends?
- Scott
Posted by schleprock on September 10, 2012, at 18:11:58
In reply to Re: Need out of the box suggestions » chicagokat, posted by SLS on September 10, 2012, at 17:36:41
You could always try a dopamine agonist(?) like mirapex. There's also pinoldol(>), a beta-blocker that I believe is being used off-label for depression.
And then, there's always another path...
Posted by jono_in_adelaide on September 10, 2012, at 18:30:16
In reply to Need out of the box suggestions, posted by chicagokat on September 10, 2012, at 10:42:19
Ask your doc about Lexapro combined with either Nortriptyline (75mg at night to start, then measure blood levels and adjust doseage up or down based on this) or Welbutrin 300mg-450mg/day
Adding an atypical antipsychotic (say Risperidone 0.5 - 1mg at bedtime) can offer a kick start to the antidepressant meds
Posted by SLS on September 10, 2012, at 18:38:46
In reply to Need out of the box suggestions, posted by chicagokat on September 10, 2012, at 10:42:19
Hi.
Ataxia is a frequent side effect with Ambien. If you do return to Nardil and the ataxia reappears, I would consider performing an experiment with Ambien by skipping one or two nights to see if the ataxia resolves.
- Scott
Posted by zazenducke on September 10, 2012, at 19:03:28
In reply to Re: Need out of the box suggestions » zazenducke, posted by SLS on September 10, 2012, at 14:40:53
> > > Where is Wellbutrin?
> >
> >
> >
> > >
> > > Have you ever tried Lamictal?
> > >
> >
> > SNRIs
> > TCAz
> > Atypical antipsychotics
> > Mood stabilizers (lithium, lamictal)
> >
> >
> > See original post above Mr S
> >
> > Never take advice from strangers on the internet :)
>
>
> You should really find a hobby.
>
>
> - ScottThanks for not suggesting I should really be medicated ;)
Posted by brynb on September 11, 2012, at 1:14:21
In reply to Need out of the box suggestions, posted by chicagokat on September 10, 2012, at 10:42:19
Hi Kat-
Push the Tramadol. I don't have any links right now to share, but google it and you'll find many hat you can show your pdoc.
It's an interesting drug (psychiatrically speaking); it's a weak NRI, a weak opiod agonist that works on the mu receptors and an NMDA antagonist. It pulled me out of my last depressive episode at only 100mg, and now I only take 50mg and it works great. I use i in combination with Lexapro (20mg) and lithium (300mg).
Nortyptiline with Lexapro is a good combo, but I couldn't really handle the Nortryptiline.
Good luck tomorrow and keep s posted!
Posted by SLS on September 11, 2012, at 2:06:03
In reply to Re: Need out of the box suggestions » chicagokat, posted by brynb on September 11, 2012, at 1:14:21
Hi Brynb
> Hi Kat-
>
> Push the Tramadol. I don't have any links right now to share, but google it and you'll find many hat you can show your pdoc.
>
> It's an interesting drug (psychiatrically speaking); it's a weak NRI, a weak opiod agonist that works on the mu receptors and an NMDA antagonist. It pulled me out of my last depressive episode at only 100mg, and now I only take 50mg and it works great. I use i in combination with Lexapro (20mg) and lithium (300mg).
>
> Nortyptiline with Lexapro is a good combo, but I couldn't really handle the Nortryptiline.
>
> Good luck tomorrow and keep s posted!
It is very good news to hear of your success with your current treatment. Lots of smiles.To what degree does tramadol inhibit the reuptake of serotonin?
- Scott
Posted by phidippus on September 11, 2012, at 4:30:42
In reply to Re: Need out of the box suggestions » phidippus, posted by chicagokat on September 10, 2012, at 14:55:58
>Prozac for years, Zoloft for months, Paxil for >years, Lexapro for many years
I can think of a couple you haven't tried: Luvox and Viibryd.
>as far as TCAs, I've tried Desipramine and >Amitryptiline
You could try Clomipramine.
>the others gave me akathisia
Akathisia is easily treated.
I would talk to your doctor about Tramadol and/or
consider going back on the Nardil.Eric
Posted by SLS on September 11, 2012, at 7:11:58
In reply to Re: Need out of the box suggestions » chicagokat, posted by phidippus on September 11, 2012, at 4:30:42
> I can think of a couple you haven't tried: Luvox and Viibryd.
What do you think of adding nortriptyline to the Viibryd? You'd be gaining NE reuptake inhibition and 5-HT2a receptor antagonism. The combination would be sort of like a more potent Geodon, but without the DA antagonism.
I would still be wary of the occurrence of serotonin syndrome with the addition of tramadol to Nardil. It would be a nice addition otherwise. I guess I would take the chance of adding small amounts to ongoing Nardil treatment, and titrate gradually as tolerated. One would want to have a list of SS symptoms to watch for. Hyperpyrexia is what usually kills people. Tramadol isn't that potent a SRI, but still...
http://www.ncbi.nlm.nih.gov/pubmed/10686795
- Scott
Posted by brynb on September 11, 2012, at 7:31:47
In reply to Re: Need out of the box suggestions » brynb, posted by SLS on September 11, 2012, at 2:06:03
> It is very good news to hear of your success with your current treatment. Lots of smiles.
>
> To what degree does tramadol inhibit the reuptake of serotonin?
>
>
> - Scott
Hi Scott,Thanks =). It's only been about three months, but I'm hopeful it'll keep up.
I'm not sure to what degree Tramadol inhibits the reuptake of serotonin. Less than Norepinephrine, I believe. I think it's structurally similar to Effexor.
Glad to hear you're responding well to Minocycline by the way! Fingers crossed...
-b
Posted by chicagokat on September 11, 2012, at 9:23:49
In reply to Re: Need out of the box suggestions » chicagokat, posted by SLS on September 10, 2012, at 18:38:46
> Hi.
>
> Ataxia is a frequent side effect with Ambien. If you do return to Nardil and the ataxia reappears, I would consider performing an experiment with Ambien by skipping one or two nights to see if the ataxia resolves.
>
>
> - ScottI'm already off the Ambien; it pooped out on me too. The only thing that helps me sleep now is Elavil, I take 25-50mg. Do you think I'd be able to stay on that if I went back to Nardil? I've heard talk of using TCAs with MAOIs.
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