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running out of AD options...Is Lithium next?

Posted by yardena on August 17, 1999, at 16:27:01

Here's the deal: I respond to SSRI's and Effexor, but the effect tapers off after a while (my depression is chronic/recurrent). Then, when the dose is increased, I don't tolerate them well and begin to suffer from all kinds of adverse effects like sleeplessness, headache, memory problems, sweating, muscle twitches, etc. Not to mention the sexual effects (you'll notice that I don't call any of these things "side" effects because I believe there are no such things as "side" effects, only desired and undersired effects. Afterall, we are putting serious chemicals into our systems) which are certainly bothersome but not always my primary concern, relatively speaking. So, my doctor suggested augmentation, and at first, each combination worked. First we added thyroid hormone, which was appropriate because my TSH was high. That was fine for a while. Then the effectiveness started to fade. So, we added ritalin, which was appropriate because my sypmtom profile included incredible hypersomnia, which was mostly due to untreated apnea. But I have kept the ritalin because, even though I am not a walking zombie anymore, its augmentation effects were very helpful. But now I am depressed again. And as for the serzone--who knows? After reading some of the online literature, it seems perhaps I should give it a while longer, as it can take a while to be effective. On the other hand, I have had the increased emotionality, tearfulness and suicidal thinking. Like someone who responded to my previous post, I also find myself crying all the time, which hadn't been such a prominent feature of my depression for a while, especially when taking SSRIs, which made it nearly impossible to cry even when I wanted to. My doctor has been trying to convince me to try lithium. Some psychiatrists have begun thinking about the chronic, so-called "atypical"* depression as similar to the depressive component of bipolar disorder and have found that some people with difficult to treat depression have responded well to lithium. Needless to say, I am wary, due to the numerous serious adverse effects that are very common in people taking lithium. What I am looking for here, in this long-winded way, is to hear from people who have taken the lithium-as-antidepressant-augmentor route, and to hear about your experiences. Also, any other successful AD cocktails I should ask my doctor about?

*Want my dissertation on the misnomer of the label "atypical depression"? My totally unscientific and uninformed, yet robustly opinionated, view is that many more women than men experience this form of depression, which includes increased sleep, sensitivity to rejection, and increased eating. I also would venture to guess that the standards for diagnosis of depression were studied primarily on male subjects, as it is clear that the scientific community has only lately come to recognize that men and women are different from each other, and get sick differently and respond differently to medications. Since more women than men tend to suffer from depression, I would also guess that the "atypical" variety of depressive illness is probably far more "typical" or frequent than is the so called "typical" version of major depression. I also have doubts about the link between "atypical" depression and bipolar illness. It seems to me that one of the reasons people with bipolar illness have the "reversed vegetative symptoms", ie increased sleep and appetite, is simply because their bodies are compensating for the deprivations experienced during the manic phase, when many people with this disorder don't sleep or eat enough. That "atypical depression" and the depressive phase of bipolar disorder share some symptoms does not feel to me like a strong enough reason to decide they are related. I AM interested to know (Dr. Bob, can you help with this one?) whether there is any evidence of a familial link between "atypical" depression and bipolar illness. There is no bipolar illness in my family, that I know of. There is plenty of depression, and some tendencies toward obsessive-compulsive patterns, especially around eating and food. There is also one case of alcoholism, which I think was self-medication of a chronic depression after the accidental death of a child, and loss of this person's entire family or origin in Eastern Europe during WWII.




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