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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by orochi on December 7, 2014, at 11:30:07
I'm pretty discouraged right now.
I simply feel like there is no drug which can help me. I have been melancholic,anxious,depressed since childhood. I know nothing else. I don't know how it is to not be depressed or to worry about losing something precious or losing people or feeling guilty for something.
Because of this I don't even know if it's even possible that you go on an antidepressant and then suddenly these depressing thoughts are gone. I cannot really imagine this.
But if antidepressants cannot make you become a different person, in my case being unnaturally happy, then what can they do?
Can they reduce the overall symptoms to a degree but you'll still feel the same feelings you always felt before?
I know that I'm not a happy,optimistic person. I also have many real issues which cause me to be depressed and not happy. I ask myself how should it be like if I found a drug which actually works? Should I then feel unnaturally happy and at the same time know that this feeling isn't natural? Or should I be emotionally numb and not feel anything compared to being depressed?
I simply can't imagine myself not being the way I am.
What if antidepressants simply cannot help someone like me? My doc once said that an antidepressant is not a "happy pill" but I needed something like a happy pill. :(So far I tried without success:
Lexapro,Wellbutrin,Ritalin,Agomelatine,Tianeptine,RemeronCurrently I'm on 75mg Anafranil and I cannot say that it makes me feel any better.
Posted by SLS on December 7, 2014, at 13:35:35
In reply to If you've always been melancholic, can ADs help?, posted by orochi on December 7, 2014, at 11:30:07
Tricyclics were once the gold standard for melancholic depression. They probably still are. Imipramine, amitriptyline, nortriptyline, desipramine are the ones most commonly chosen. I like imipramine if you want the best chance of responding. I like nortriptyline if you want the fewest side effects.
You should have been started on a SNRI. I would go for Pristiq first. If Wellbutrin helped at all, you might want to consider combining it with the SNRI.
- Scott
Posted by baseball55 on December 7, 2014, at 19:34:52
In reply to If you've always been melancholic, can ADs help?, posted by orochi on December 7, 2014, at 11:30:07
> But if antidepressants cannot make you become a different person, in my case being unnaturally happy, then what can they do?
> Can they reduce the overall symptoms to a degree but you'll still feel the same feelings you always felt before?
> I know that I'm not a happy,optimistic person. I also have many real issues which cause me to be depressed and not happy. I ask myself how should it be like if I found a drug which actually works? Should I then feel unnaturally happy and at the same time know that this feeling isn't natural? Or should I be emotionally numb and not feel anything compared to being depressed?When drugs have worked for me, I did not feel happy, nor did I feel numb. I just didn't feel overwhelming despair anymore. I felt functional. I still had things in my life that made me unhappy. I still felt sad sometimes. I still struggled with psychic demons. But I was able to deal with some of this and to actually get some benefit from therapy to deal with the emotional issues.
Posted by SLS on December 7, 2014, at 22:46:07
In reply to Re: If you've always been melancholic, can ADs help? » orochi, posted by baseball55 on December 7, 2014, at 19:34:52
> When drugs have worked for me, I did not feel happy...
> I still had things in my life that made me unhappy...
> But I was able to deal with some of this and to actually get some benefit from therapy to deal with the emotional issues.
I couldn't agree more. Thanks for making a very important point.
- Scott
Posted by Christ_empowered on December 7, 2014, at 23:48:11
In reply to If you've always been melancholic, can ADs help?, posted by orochi on December 7, 2014, at 11:30:07
Tofranil (imipramine)/Tofranil PM helped me. If there's intense anxiety and/or agitation, adding a benzo and/or low dose AP/AAP can help, too. Triavil (perphenazine plus Elavil) used to be the go to drug for this. When I took Tofranil w/ Abilify, the results were pretty good. I just dropped the Tofranil for Lamictal, which works better for me.Good luck!
Posted by SLS on December 8, 2014, at 6:19:07
In reply to Re: If you've always been melancholic, can ADs help?, posted by Christ_empowered on December 7, 2014, at 23:48:11
> I just dropped the Tofranil for Lamictal, which works better for me.
What dosage of Lamictal are you taking?
How long have you been on it?
Thanks.
I wish you continued success...
- Scott
Posted by burial on December 8, 2014, at 11:21:06
In reply to Re: If you've always been melancholic, can ADs help? » Christ_empowered, posted by SLS on December 8, 2014, at 6:19:07
i've always thought that melancholy responds best to drugs, that really push norepinephrine. Effexor + Nortriptyline would be your choice or something similar
Posted by Christ_empowered on December 9, 2014, at 19:44:31
In reply to Re: If you've always been melancholic, can ADs help? » Christ_empowered, posted by SLS on December 8, 2014, at 6:19:07
just 100mgs, several months. I also take 1200 trilepal and 30 abilify.
Posted by phidippus on December 10, 2014, at 13:46:09
In reply to If you've always been melancholic, can ADs help?, posted by orochi on December 7, 2014, at 11:30:07
How long were you on the Lexapro and the Remeron? What doses did you take?
How long were you on the Wellbutrin and at what dose?
How long have you been on the Anafranil? 75 mg is a very low dose and you probably won't see any benefit until you reach a 150-200 mg dose-mind you you need to have been at that dose for at least 6 weeks.
Tianeptine works by stimulating opioid receptors in the brain and has 2.5 hour half life. It is not an effective antidepressant.
Agomelatine is a melotanergic agent that doesn't work like normal antidepressants. I'm surprised it works at all.
Depression and anxiety cause 'distorted' thinking which can be helped with serotogenic agents and therapy, mainly cbt/dbt. While you're taking an antidepressant at the right dose for the right amount of time you will start to notice changes in your thinking as well as changes in your overall mood. It doesn't happen overnight, but rather gradually.
Are you in therapy?
Eric
Posted by orochi on December 15, 2014, at 17:35:16
In reply to Re: If you've always been melancholic, can ADs help? » orochi, posted by phidippus on December 10, 2014, at 13:46:09
Hi everyone,
I feel terrible right now. Absolutely terrible.
I have to get off Anafranil because it makes my heart race too much. I am down to 10mg. But the reason for feeling terrible isn't the reduced dose it's my circumstances.
I got some bad news yesterday and now I feel absolutely down again. I have so many problems they are totally overwhelming. Every time I am facing a problem I become totally overwhelmed. For a while I can suppress thinking about them and during this time I may feel so so but once I am reminded of one of my many problems (like being reminded of a sickness or being reminded of my personal situation or thinking about how bad my overall situation is) then it totally knocks me down!
I cannot even tell if an AD works or not cause during my "so so times" I may think it could be working a bit but in fact it is not! I can only tell wether an AD works or not if it helped me during these really bad times and no AD did.
I don't know what to do now. I tried therapy. It was a joke. It only made me feel worse. The advice were so generic. Like for example "don't think about your diseases accept them" how is this supposed to help me??!?
I cannot simply accept them! If I could I would have done it years ago. :(
My situation is so grim that there is basically no advice which comforts me. When I talk to someone about my situation (and I dont have many to talk to) then for a short while I feel better but after weeks or months I am again reminded how bad everything is and then I feel totally hopeless again.
I have simply too much to deal with. I have many physical ailments. They alone would be more than enough to be depressed about. But then I also ruined my life with false decisions. I ended up studying something which I'm not good at and which also doesn't really interest me and now I'm terribly afraid of the final exams and I keep pushing them back but I can't escape them. They are before me and I simply feel like there is no way I can do this. The fear is simply too strong and this fear has been building up for YEARS!!!
I cannot count how many times during my study years I felt like this is it and would just have given up if I could have. Instead I had to drag on and suffered and now at the very end where I face the final exams I feel like I just cannot do it.
And there is no plan B for me I'm way too old for that. I cannot simply study something new. Already now everything is a total mess. My doctor also once told me this. He looked at me totally concerned and asked me who's supposed to hire me with my terrible vitae. How shall I explain this to someone that I have been studying something more than twice as long as normal students? What shall I say? That I suffer from anxiety and depression and was afraid of the finals? Something like this is a red flag.
And besides this with my bad health and strong depression I don't even see me working in a job. I am not functional at all! Most of the time I am already in bad shape when I simply at home lying on the couch dealing with my own issues. How shall I make it in life? I really dont know. :(Basically I go to my doc and tell him that the AD didnt work and discuss options. But there isn't really time to discuss personal issues. He doesn't really know how bad everything is. There's no time to bring such things up. His waiting room is always full. And psychiatrists usually also don't really want too much details they simply prescribe drugs.
I took celexa at 20mg for 8 weeks.
Remeron at 30mg for maybe 6 weeks.
Wellbutrin at 300mg for 8 weeks it didnt do much.
Tianeptine for 5 weeks during this time I felt really bad but I dont know if it was because of the drug or not
I also tried memantine at 20mg for 5 weeks. It also didn't really do much.
Posted by orochi on December 15, 2014, at 18:00:10
In reply to Re: If you've always been melancholic, can ADs help?, posted by orochi on December 15, 2014, at 17:35:16
What if normal ADs simply dont work for me?
What should I do then? It already wasn't easy to get my doc to let me try memantine cause it's not an AD.
I dont know if other drugs which are against bipolar or seizures might work for me but they usually also have much more side effects which then scare me. I really have no clue what to do. :(
I only know that I have real psychiatric issues. I have been having ocd and anxiety since childhood. The more I think about my life the more I realize how I always used to be afraid of things. It wasn't a panic attack fear but always a constant fear. Even when I go outside of the house into the public or when I go to the doctor and there is no real threat I still feel uncomfortable and I'm not in a relaxed state.
I am scared of many things which other people are not afraid of like for example using public transportation at night or driving long distances or even when I was on vacation I was also afraid cause you never know what might happen. It has been like this my whole life. Something is definitely not going normal in my brain. I just dont really think that it can be fixed. I cant imagine myself every being functional or happy especially not with all my problems which dont go away. :(
Posted by orochi on December 15, 2014, at 18:07:16
In reply to Re: If you've always been melancholic, can ADs help?, posted by orochi on December 15, 2014, at 18:00:10
I forgot, I also tried Lyrica. But only up to 100mg and then I got afraid cause I had the impression that it makes my memory worse. But now I'm not sure of Lyrica really did it or not. The issue is that since I'm a student and need to memorize things I am afraid of drugs which are known to dumb you down. Then I'm worried all the time and think what if it makes my memory worse?
I also read that Lyrica does things in the brain which are the exact opposite of what happens when you learn new things. It sounded really not good to me.
Posted by phidippus on December 15, 2014, at 18:29:47
In reply to Re: If you've always been melancholic, can ADs help?, posted by orochi on December 15, 2014, at 18:07:16
I never experienced any memory problems while on Lyrica-I took 600 mg a day.
Posted by phidippus on December 15, 2014, at 18:40:59
In reply to Re: If you've always been melancholic, can ADs help?, posted by orochi on December 15, 2014, at 17:35:16
You're stuck in rut.
How did you feel when you were on say, Remeron?
Eric
Posted by baseball55 on December 15, 2014, at 21:05:27
In reply to Re: If you've always been melancholic, can ADs help?, posted by orochi on December 15, 2014, at 17:35:16
I know you don't want to hear this, but the only way to find some peace is to practice acceptance. You may see this as lame advice - how can I accept things that are unacceptable? - but by seeing the situation as unacceptable, you are causing yourself additional pain and worry.
I say "practice acceptance" because there are tools and skills you can learn to become accepting and find some psychic peace. Have you tried a DBT therapist? Or a good CBT therapist?
Posted by ed_uk2010 on December 16, 2014, at 9:24:41
In reply to Re: If you've always been melancholic, can ADs help?, posted by orochi on December 15, 2014, at 18:07:16
Orochi,
I sent you babblemail.
Posted by SLS on December 16, 2014, at 9:36:29
In reply to Re: If you've always been melancholic, can ADs help? » orochi, posted by baseball55 on December 15, 2014, at 21:05:27
> I know you don't want to hear this, but the only way to find some peace is to practice acceptance. You may see this as lame advice - how can I accept things that are unacceptable? - but by seeing the situation as unacceptable, you are causing yourself additional pain and worry.
>
> I say "practice acceptance" because there are tools and skills you can learn to become accepting and find some psychic peace. Have you tried a DBT therapist? Or a good CBT therapist?I try to accept my condition in the moment so that I can squeeze as much out of life as possible. However, I consider my condition to be unacceptable. I try to tell myself that my letting go of my illness and accepting it in the moment will not impact my resolve to search for a cure. I find that to always view the moment within the context of how my illness affects it is actually a form of multitasking that steals energy, concentration, mood, and functionality. I still do it, though - just not as often.
- Scott
Posted by baseball55 on December 16, 2014, at 19:40:38
In reply to Re: If you've always been melancholic, can ADs help? » baseball55, posted by SLS on December 16, 2014, at 9:36:29
Thank you for sharing that Scott. I thing the problem becomes even more disabling when, in addition to try to cope with depression, one is trying to cope with all kinds of negative self-talk -- I am a failure, I am pathetic, there's no hope for me, I will never be better.
Posted by tom2228 on December 19, 2014, at 0:41:52
In reply to Re: If you've always been melancholic, can ADs help?, posted by burial on December 8, 2014, at 11:21:06
> i've always thought that melancholy responds best to drugs, that really push norepinephrine. Effexor + Nortriptyline would be your choice or something similar
orochi, I first: have to say your first post on this thread succinctly sums up the mental anguish I have about psych meds -- Will they ever work/ were they actually f***ing work for me when it seemed like they were before, or were those tiny tiny improvements that I perceived to be larger improvements effected by the shrouded reality of the drug?
second: I too have struggled with this type of melancholy/ anxiety since little, and it too has only responded marginally when the drugs worked. The drugs worked well enough for me to feel better about the situation even though they produced minor improvements in the big picture. I have been so aggressively treating my depression this year that I realize just how small of a percentage of acceptable change these drugs have effected for me throughout the years, despite feeling immensely helpful to shave a tidbit of the struggle off.
But... despite clouding the clinical picture that I have been only 1 week off of crystal meth and being on else med-wise, I can possibly say that I may have truly found what proper relief of melancholy from an antidepressant feels like!! And I have to agree with SLS and burial that I too strongly believe this comes from pushing norepinephrine really hard, and with a tricyclic -- Wellbutin didn't do it for me but desipramine really is.
About a month and a half ago my Abilify was lowered from 9 to 8mg and my desipramine ~doubled to 125mg, and take into account I am also on the MAOI Marplan. I've been on all of my meds long enough to tell what's doing what lately, and I can comfortably say that deispramine not fully comprehensive but STRONG and effective for my melancholia.
My mood seems to be firmly lofted on a cloud that ground troopers keep trying shoot down but man I can barely hear them and at best can steer this ship to smoother skies. There is a pleasant "high" to my mood that feels like it always should have been there -- it is ego SYNtonic in that it just gels with me. Maybe it's a bit unnatural but 1) I am an addict and taken close to 50 psych meds so who gives a f*ck at this point? and 2) This drug just feels a stable good mood on top of what it feels like to be myself. Several drugs have "changed" that feeling of sense of self and this one does it in a way that agrees with me. I have been on a long journey of weeding through the crappy ones and almost piling on layers of the drugs that feel ok until they begin to become limited by dose-related side effects. See my list at the end.
But this cloud feels like the periods and facets of normality I have experienced throughout life and what the rest of society who lives without a mood disorders seems to me to existing on when we interact and explains why the hell they've all been here for years doing their day jobs without ending their lives. They're simply not melancholic.
My anxiety is also at an all time low despite the sh*t I'm dealing with and the hell called crystal meth withdrawal that I'm coming up from. I have to say though, the desipramine seems to really help the cravings and desire to use meth (heard the same about Strattera). The sequence of doubling the antidepressant before quitting the meth has seemed to have layed some thorough groundwork for my brain to work with now that the neurotransmitters have started to come back. The anxiety tho -- it's as if things are rolling off my shoulders... minutely and restrospectively when I see how easily I am navigating some pretty serious problems.
The only other thing I can think about is that I'm on the "honeymoon" phase of meth recovery -- more generically called a "pink cloud" -- but isn't that what tricyclics supposed to do for us? The significance? We shall see :)
In sum I am pleasantly taken aback by tricyclic antidepressants. I took nortriptyline half a year ago at 75mg and enjoyed that as well, but whatever the dose eqivalency, or other circumstances, desipramine is being so nice to me..
desipramine 125mg
Marplan 40mg
Desoxyn 30mg
Deplin 30mg
Mirapex ER 0.375mg
levothyroxine 50mcg
lithium 900mg
Lamictal ER 100mg
Abilify 10mgall vitals OK no worries!
Posted by Robert_Burton_1621 on February 16, 2015, at 20:27:58
In reply to If you've always been melancholic, can ADs help?, posted by orochi on December 7, 2014, at 11:30:07
> I'm pretty discouraged right now.
> I simply feel like there is no drug which can help me. I have been melancholic,anxious,depressed since childhood.
>> What if antidepressants simply cannot help someone like me? My doc once said that an antidepressant is not a "happy pill" but I needed something like a happy pill. :(
>
> So far I tried without success:
> Lexapro,Wellbutrin,Ritalin,Agomelatine,Tianeptine,Remeron
>
> Currently I'm on 75mg Anafranil and I cannot say that it makes me feel any better.Hello orochi,
I am really sorry to hear of your persistent melancholia and the absence of relief you have experienced.
How are you going now?
Have you been diagnosed with a melancholic depression?
I am no expert by any means, but the medications you have trialed so far don't seem to me as targetted to succeed in melancholic cases.
I wonder whether it is prudent for you to obtain a second opinion about your medication regimes.
In my case, I achieved a moderate response to the combination of sertraline and nortriptyline (a tricyclic). Tricyclics are more likely to be helpful to someone with a melancholic condition. The combination I was on for six months used an SNRI stratgegy but was more potent, particularly on noradrenaline, that the SNRIs with fixed relative potencies like Effexor and Cymbalta.
This was not the solution for me, but it kept me above water. But older psychiatrists attest to its effectiveness in melancholic and some psychotic depressions.
Also, it doesn't seem you've tried an MAOI. Are you confident to raise this option with your psychiatrist? Don't be discouraged if he or she dimisses it: many do not have sufficient learning of the properties of this class of drugs which have been clarified in recent years.
They are reputed to be very effective. I started on parnate 13 days ago and had a positive if mild response within 48 hours. That response is gradually improving and it is early days.
I just wanted to stress: don't give up hope on the basis of inferences drawn from the inefficacy of your previous medications. There is nothing to show from them that your chances of responding to an alternative class like a TCA or MAOI have cumulatively diminished because of the number of drugs of separate classes you have tried thus far.
Best wishes, and make a point of reminding yourself now and then that fatalistic, pessimistic, and black/white styles of thinking are characteristic of what depression does to your cognition and reasoning. If you can, try to step back from those thinking processes and interpret them as symptoms of your depression, and thus unreliable, rather than lucid assessments of the options you have available to you.
This is the end of the thread.
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