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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Meatwood_Flack on January 2, 2013, at 20:09:31
Happy New Year, everyone!
As of this month, I have been battling a what seems to be a severe, melancholic (endogenous) depression for a year, with no relief despite trying several different medications and combos of meds. I have tried Zoloft (all the way to 150 mg with no changes other than a half dozen afternoons over the space of three weeks where I felt much better from about 4 p.m. until bedtime), Effexor (all the way to five weeks at 120 mg. when it was replaced by Cymbalta in hospital last summer), Cymbalta (all the way up to 120 mg. and remained on this for several months with no relief), Cymbalta was augmented with Abilify (up to 5 mg.), Wellbutrin (at 150 mg.) and Lamictal (up to 100 mg.). Was also on the following for sleep: Trazodone (now at 150 mg., my second round with this med), Atarax (2550 mg.), Quietapine (100 mg. for both sleep and depression, discontinued due to some myoclonic jerks) and Clonazapam (I believe 10 mg., which my regular pnurse discontinued as soon as I was released from hospital. Am now going into week three of 20 mg. Prozac and just titrated Wellbutrin up to 300 mg. I've read that SSRI drugs perform about as well as placebos except in cases of severe depression, where the placebo effect basically disappears. Between my readings about various drugs on PubMed and writings by Breggin, Whitaker, Szasz, it's all quite confusing. I have also read that 30 percent of depressed patients don't respond to anything. I'm wondering if the placebo effect has been overstated, as lots of people seem to find relief from these drugs, and I suppose part of me wishes I could find out, definitively, that my condition is not of biological origin and is, therefore, amenable to other avenues, such as talk therapy, diet or exercise. My new psychiatrist wanted to try Prozac because my father found depression relief with this medication for his own, long-standing depression, which makes sense in a way, but he is also hesitant to prescribe tricyclics because, "A week's supply can kill you." I replied that, previous to my depression, I was an active and occasionally gigging musician and, as such, had numerous instrument and microphone cables that could be just as lethal, aside from the fact that if the TCA worked, there would be no impetus for self destruction. My symptoms are depressed mood that is nonreactive and improves somewhat by night (worse in the morning) anergia, lack of appetite, insomnia, anhedonia (one of the worst symptoms, as my music and writing have basically ceased since the depression, since I no longer get any enjoyment out of the two most previously enjoyable pastimes of mine, besides sex, which has, likewise, gone down the tubes. I'm not even sure what my actual question is, aside from being confused by contrasting literature and my own lack of progress, despite a plethora of pharmacalogical interventions. I suppose I'm grasping about for hope (though not at the expense of honesty), since I've been unemployed for nearly four months because of this, not to mention the damage it's done to my interpersonal functioning (Christmas and Thanksgiving with the fam was rough since I also seem to be overstimulated by just about anything.) It's also become increasingly difficult for me to even leave the house and all I want to do is sleep so I can get at least some temporary relief. Any insights, personal experiences or advice would be greatly appreciated. I can't keep this up indefinitely...
Posted by rjlockhart37 on January 2, 2013, at 20:39:55
In reply to Placebo?, posted by Meatwood_Flack on January 2, 2013, at 20:09:31
hey....i read your post over and over again....let me get this right...clonazepam...is it still in use? i was on clonazepam in 2005, not really a long time, maybe about a year...it made so depressed, i could not even stand getting up from the bed, its vary good for panic attacks, and siezures, but it just does something to serotonin, i read somewhere that it decreases the output of it....ill have to find the source somewhere on the net. Lorazepam or Alprazolam would be so much more better for you, of course im not a doctor...xanax is used in depression cases with anxiety. But....that feeling of not wanting to get up, everything seems...like there no life in it, no pleasure, everything seems bland... could your doctor can put you some a stimulant, or maybe MAOI like Parnate, but if your not responding to much, usally the last resort medications will be used. Then there's the other options like pave makers in the brain, or shock therapy, which i would never recommend. Maybe increase the wellbutrin to 450mg, add provigil, or dexedrine....concerta anything that would increase dopamine...dopamine makes you intrested and motivated, serotonin is more like...bliss and happy, dopamine makes you get things done, and .. i think that would help with the music because the depression your having right now is ... causing all this bland, nothing like feeling. Could you maybe switch benzos? klonopin is depressing even though its perfect for severe anxiety, ativan will also cause depression, xanax is ... a good option for this. You could have talk therapy here on babble....i know this website is not like the Oprah Winfrey Show, i could research some stuff....
Posted by Meatwood_Flack on January 2, 2013, at 20:53:16
In reply to Re: Placebo?, posted by rjlockhart37 on January 2, 2013, at 20:39:55
My bad, it was Temazepam that I was on. Mom is on a low dose of Clonazepam for sleep. Now Im back on Trazodone (150 mg.) for sleep and it's hit or miss for that. Some nights I can fall asleep without it, some night's I get a decent amount of sleep on it, and some night's I only get 3 to 4 hours of sleep with it. Due to financial limitations, I am being treated through the Native American tribe of which I am a member (even with only 1/16 blood, but I have a relative on the original roll, so....) and their mental healthcare system does not use MAOI's due to side effect profiles. ECT is out for both financial reasons, plus the fact that even if I could, I don't think I would spend $30,000 for memory loss and temporary depression relief (if even that.) I'm not sure how I would go about requesting a stim without looking like I'm drug-seeking, especially this early into the Prozac/WB trial. Same for Xanax.
Posted by rjlockhart37 on January 2, 2013, at 21:06:36
In reply to Re: Placebo? » rjlockhart37, posted by Meatwood_Flack on January 2, 2013, at 20:53:16
ohhhhhhhhh sorry....provigil is not really seen as a addicting stimulant...my doctor is an addiction specialist, she deals with addicts...and knows of my history of stimulant abuse...but after time this depression got so bad...i called over again, and she put me on Nuvigil 250mg. I do think it would help, but im not the doctor. Yea 20mgs of clonzpeam....that is a incredibly sedating 5mgs 4 times daily goodness... that's usally used for grandmal siezures.
There's something called Remeron...i think its misspelled but may help both with sleep and depression...some people here on babble have taken it.
Just tell your doctor of the energy loss, and go specific in how it affects daily life. Maybe .. maybe the'll get a hint to use some kinda of stimulant, provigil i think would be the best.
But what caused this? was there trauma that happened?
Posted by Meatwood_Flack on January 2, 2013, at 21:39:32
In reply to Re: Placebo?, posted by rjlockhart37 on January 2, 2013, at 21:06:36
Source of the trauma....that's a tough one. I started experiencing minor depressions as a kid. Teachers held me up as an example because I was one of the so-called "smart kids" (In second grade, other teachers would have me come read to their second graders.) Many kids who are not singled out this way take offense, either out of feeling left out or because they don't feel like they can relate to the "smart kids." Intelligence is rarely rewarded on the playground, at least by fellow students. Poof goes self esteem. By junior high I had figured out that I could use my sense of humor to build common ground and deflect from my "egghead smartyart bookworm" status. I wasn't the most popular student in my class, but was well-liked. Music further helped my sense of self worth because I was the kid in high school who could draw a crowd at the piano by playing songs that were popular on the radio. But the underlying feeling of not measuring up remained, even if it was in the background a lot of the time. But, back in the 80's, who knew from depression, especially since I was functional, albeit kind of a glass half empty kind of dude. The low grade feeling of inferiority persisted, even though I earned a college degree and could attract people with either my music, sense of humor or writing. So, throughout the 90s and even beyond, I would periodically get down in the dumps for a little bit (never for really long) and then return to baseline, so to speak. About three years ago, I experimented over the summer with something called Spice, a legal drug that mimiced the effects of marijuana, although often more strongly. One night, while smoking alone, I had this horrible fear that I was going to kill myself. It was like I had a split screen in my mind, with the fear on one side and me on the other side, saying, "Chill out, you just smoked too much." So I didn't smoke it again for nearly a month, then tried it a few more times before experiencing the same irrational fear, not while under the influence, but the day after smoking. I was sitting in a movie theater, watching The Expendables when it hit. I was distraut over this for the next couple of days then forgot about it for several months when, at odd times, I would experience a low grade panic because the feeling or memory of the feeling would come back. These odd re-experiencings occurred at odd times during the year leading up to the onset of my depression and, in fact, at the time it hit, I was in counseling for anxiety from that, although I learned about intrusive thoughts and how to deal with them. My method that seemed to work the best was to make fun of them. Also, during this time, I made two trips to the ER for elevated blood pressure, got on medication and, in an effort to further help my blood pressure along, stopped drinking alcohol (I was a 10 beer a night man and had been drinking most nights for a number of years, while remaining functional enough to work and be a productive family member and friend). After I'd been off the alcohol for a week or so, I decided to quit a 30 year smokeless tobacco habit, as well. Two weeks into that quit, the depression landed on me like an anvil and it's been there ever since (I went back to tobacco and it didn't help except for providing light and fleeting relief for the first four or five days.) I also attempted to go to grad school a couple of years ago to become (ironically) a therapist but, due to a couple of snafus beyond my control, that path was aborted (although I always maintained plans to try again), so that may factor in, as well. It's a lot to try and tease out, how much weight to give each event, let alone how to resolve it all, as well as the question of whether or not "resolving" it all would resolve my depression.
Posted by Phillipa on January 2, 2013, at 22:32:16
In reply to Re: Placebo?, posted by Meatwood_Flack on January 2, 2013, at 21:39:32
Slow down and do one thing at a time reguarding meds. Phillipa
Posted by jono_in_adelaide on January 2, 2013, at 23:02:25
In reply to Placebo?, posted by Meatwood_Flack on January 2, 2013, at 20:09:31
I'd stick with the Welbutrin + prozac combo a bit longer, push the Prozac to 60mg and the Welbutrin to 450mg if needed.
Next step might be tranylcypromine (Parnate) with or without nortriptyline.
Its endrogenous depression where antidepressants perform best - its mild neurotic depressions where they arnt of much benifit
Posted by rjlockhart37 on January 3, 2013, at 22:19:40
In reply to Re: Placebo?, posted by Meatwood_Flack on January 2, 2013, at 21:39:32
first thing i have to say....spice, or maryj's i smoked maryjay at a friend house one time....thinking it would ease me off...and make me socialble, the worst happened......after smoking maybe the 4th puff...i got real lightheaded, and then got a feeling like i was losing reality...or kinda like that feeling when your going to sleep into dreamland...that's what happpened, and my thoughts started making no sense, riddle like thinking, and then my body released tons of adrenaline because its the flight fight response when something unknown happens in the body or the mind. I stayed like that....for 2 hours, i had to lock myself in a bathroom, and keep trying to keep myself with reality.....and i thought lucifer was going to take over my body....just crazy sh*t...it wore off...and big relief....but those wierd thoughts stayed with me even after I smoked it. So spice...i smoke spice one time but not enoght to get an effect, its not legal here in texas anymore...i smoked i think last year bored....so psychedelic, or ... marianua stuff can alter thinking into a new wierd like thought...you think things you never thought before, and then they stay with you even after your sober. Try to do something like erase all that memory of suicide...sadness, just try to undo it, think of something tha will block it from popping up...
but to your childhood days....yea i wasnt much of a brilliant mind....i was pretty bad on tests...and below average on SAT and TAAS test...so i was on the opposite end of smart and dumb...i was the dumb end...lol....i always loved music, listen to radio heard tunes and then started using them to visualize a life fantasy of being a big shot, all these pipedreams...usally when i listen to music today i always think of life situation, or fantasy....and listen the song over and over again until i get tired of it...lol had a tune in my head while a walked around the mall tryin to show off....dumb stuff...
music is like a creativity thing....hs lots of forms, lots of emotions, and can be created from anything....even from nothing.
The thing is....and i should be doing this too....is to redo, map out the thoughts, and put into sections to make it understandable, then work with mind change...change beliefs, change ... ideas, expectations, and change the view of shame. That really could make things better...prozac and all the SSRI drugs don't make those deep cases of depression ... someone thinking of a grey buiding that's abandoned...gloomy, dark, and vary heavy sadness. Medication can't change that mindset, it has to changed in the mind.
block or even run over the negative stuff of being inferior. I feel inferior all the time....the worst thing that can happen to me is acting superior to others and then do something so incredibly stupid....people just look and laugh.
Maybe...start having a glass of wine...not alot but maybe something to at least take care of this for a while, until medication changes can happen. I think some kinda of benzo would help....temazepam is good but its only for sleep. Nuerontin....yes ask your doctor about that...that's good for nerves and mood.
Anything else happen....just pretend im Oprah. lol...talk therapy really can help getting things out....
r
Posted by rjlockhart37 on January 3, 2013, at 22:23:06
In reply to Re: Placebo?, posted by rjlockhart37 on January 3, 2013, at 22:19:40
This is the end of the thread.
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