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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by iris2 on December 23, 2004, at 14:40:00
Thank you for being our guest expert.
I have a treatment resistant depression and bulimia for 30 years now. I am unable to take almost any antidepressant because of interstitial cystitis.
I recently took an antipsycotic and it helped a little with my depression. I gained a lot of body fat around my waist. I had been content with my weight and body many years and was rarely actively bulimic. I became so upset over the changes in my body, increased prolactin, menses stopping and weight gain that I decided to go off the medication.
I cannot seem to get any rational advice from anyone. On this site people continually post accounts of not being willing to take medications if they gain any weight or that weight gain is a logical cause for "depression" as apposed to unhappiness or taking antidepressants to loose weight as an end result. My family on the other hand thinks I am completely irrational to bother thinking about the weight gain at all.
I feel traumatized and have no solid ground to stand on. Your input and advice would help me understand how I should think about this and I would appreciate it.
Thank you,
Irene
Posted by Dr. Beth Steinhauer on December 23, 2004, at 16:43:46
In reply to Steinhauer-Eating disorder and Depression, posted by iris2 on December 23, 2004, at 14:40:00
Dear Irene,
I am sorry that you have had such a difficult time. I am hopeful that you can find help for both your depression and for the bulimia.
You didn't mention which antipsychotic was tried, but some of the newer atypical antipsychotics have shown great promise in stabilizing mood disorders. Some, like olanzapine (Zyprexa) are known to cause weight gain quite commonly, but others, e.g. ziprasidone (Geodon) and possibly aripiprazole (Abilify), are less likely to cause weight gain. You may want to discuss this with your psychiatrist. Also, certain antioconvulsants can be very effective mood stabilizers. Lamotrigine (Lamictal) has antidepressant properties, and unlike Lithium and Depakote, does not cause weight gain. Electroconvulsive therapy is a VERY effective treatment for depression that is underutilized in this country, mostly because of mistaken impressions of what the treatment involves. (Many people have heard horror stories that are outdated; ECT did used to be a more barbaric treatment in the 1950s.) It is actually quite safe, alleviates depressive symptoms quickly, and can be administered on an inpatient or an outpatient basis. Certainly, your interstitial cystitis would not be a contraindication for ECT.
Apart from biological treatments, such as medicines and/or ECT, psychotherapy can be extremely helpful for both depression and bulimia. Cognitive-behavioral therapy has demonstrated effecacy for both conditions, and other talk therapies may be helpful, either alone or as in combination with medication/ECT.
I understand your concern about weight gain and bodily changes due to medications, and I don't share your family's views on this score...but it is possible that if you felt less depressed, you would be in a better position to manage any weight gain constructively, e.g. through increased activity and exercise.
Best of luck to you. ES
Posted by Dr. Beth Steinhauer on December 24, 2004, at 15:22:01
In reply to Steinhauer-Eating disorder and Depression, posted by iris2 on December 23, 2004, at 14:40:00
P.S. for Irene
I was able to check with a colleague who is an internist, who suggested that interstitial cystitis is not a contraindication for most antidepressants. In fact, she said that internists often TREAT conditions like interstitial cystitis (also fibromyalgia, chronic pain syndromes, etc.) with SSRIs. Just a thought...
Posted by iris2 on December 26, 2004, at 13:25:02
In reply to Re: Steinhauer-Eating disorder and Depression, posted by Dr. Beth Steinhauer on December 24, 2004, at 15:22:01
Thank you. I am aware that interstitial cystitis is sometimes treated with antidepressants. It is not rare though I believe that people with this disease are not able to take most or any of them without having a flare up. It is not only antidepressants that I have been unable to take but also many other classes of drugs. I have tried many anyway even though the usual result is a flare up that generally does not go away for months or without other intervening treatment such as DSMO. My psychiatrist pretty much gave up suggesting medications to me when I started having problems taking them because he has two other patients with I.C. who are also unable to take most medications. After several years of not trying anything I decided to try medications again and although it is giving me some hope I have had flare-ups with almost every one I have gone on to try.
The specific issue I was trying to get a better grasp on by writing to you was dealing with the conflicting motivations of weight gain and alleviating the severe depression (with medication) all the while suffering from an eating disorder and the accompanying irrational thinking about weight and body. Most especially given the limitations I have taking any medication at all.Thanks again,
irene
Posted by Pfinstegg on December 27, 2004, at 18:36:33
In reply to Re: Steinhauer-Eating disorder and Depression » Dr. Beth Steinhauer, posted by iris2 on December 26, 2004, at 13:25:02
I think an under-reported complication of Zyprexa (and possibly some or all of the APs) is that the weight gain is associated with metabolic syndrome (unfavorable changes in blood lipids and glucose levels). Even in quite young people, this can lead to diabetes. Because you have an eating disorder, I think it would be extremely hard to add on these probable complications.
Do all classes of AD's cause flare-ups of the interstitial cystitis? What about the tricyclics? I have personally had success with TMS, and would consider ECT, as Dr. Steinhauer suggests, if I first looked into the treatment outcomes of the center I was considering having it at.
Posted by iris2 on December 30, 2004, at 12:31:19
In reply to Re: Steinhauer-Eating disorder and Depression » iris2, posted by Pfinstegg on December 27, 2004, at 18:36:33
Thanks for the response. I recently had a bunch of stuff tested at the endocrinologist and they said everything was in normal range. Strange thing is that I am continuing to gain a bulging and fatty midsection and have started having sweats several times a day sometimes. I also have not gotten my period back since I was on Amisulpride and my prolactin went up even though they said it was back to normal now. If I was not so depressed and immobile I would feel less hopeless about it all, as I would be able to think I could exercise and slim up the bulges. I have not gained any weight with it.
I have had ECT sessions twice already with no result. The SSRI's have not seemed to cause flare-ups but neither have they helped at all and I have tried several of them several times. More stimulating meds seem to be the most helpful and the ones I can least take. I have not tried tricyclics for years so I do not know if I would flare from them. My pdoc has not thought they would help me and so did not try them. He would if I asked and I was thinking about it. The problem is that when I did take them I was allergic to one and I cannot remember which one and the other I had a lot of side effects too. I do not think I was on them long enough to know if they would have helped. What is TMS again and what kind of center are you talking about? Do you have eating disorder and depression?
irene
Posted by Pfinstegg on December 30, 2004, at 18:19:11
In reply to Re: Steinhauer-Eating disorder and Depression, posted by iris2 on December 30, 2004, at 12:31:19
I have Complex PTSD, with depression and anxiety, due to childhood sexual/physical abuse. I mentioned TMS- Transcranial Magnetic Stimulation- it's not yet an approved treatment, but is similiar to ECT, but using magnetic, rather than electrical stimulation. I think it's generally considered to be less powerful than ECT, but it's easy to take. It takes just 20 minutes, and you can drive yourself home, as you don't suffer any memory loss. I have received it four times from Dr Mark Hutto of Atlanta. It helped a lot for several months, but does need to be repeated.
I'm sorry to hear that ECT didn't work. Have you given the MAOI's or Wellbutrin a try?
Posted by iris2 on December 30, 2004, at 21:04:20
In reply to Re: Steinhauer-Eating disorder and Depression » iris2, posted by Pfinstegg on December 30, 2004, at 18:19:11
Yes I took MAOI's for many years and they helped but they stopped working gradually and now not at all for several years. I also tried wellbutrin I think twice but it too did not help. There is not much I have not tried. Feeling kind of hopeless tonight. Sorry.
Hope you are faring better,
irene
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