Posted by MarkinBoston on September 19, 2000, at 3:59:56
I'm new here and am a little overwhelmed with how much cumulative experience I'm seeing in all the posts. I want to know what drug to try next and hoping for a flow chart, or at least some suggestions.
My story:
40yo single white male, 5'10", 260lbs., stage I hypertension, 20yr history of endogonous melancholic unipolar dysthymia with 6 major depressive episodes that have resolved with Effexor, sometimes + nortryteline. The major episodes usually followed long periods of job stress and have a SAD component. SSRI's initially worked on the major episodes, but no longer do. I go for meds when I feel a major approaching ( trouble working, memory problems, thinking problems). Dysthymia has not responded to anything and my chief complaints are suppressed affect, low motivation, no joy, no libido, ED, morning insomnia. I discontinue meds after the major resolves due to weight gain, apathy/demotivation, inorgasmia, evening insomnia, and excessive sweating.I've just gotten a full(ish) blood work up showing low testosterone, high estrogen, high cortisol (DMT suppression, though, and I felt GREAT after the dexamethasone). I feel good on testosterone supplimentation, but more depressed and PMS'y when my level is tried to be raised to normal median levels. I assume this is due to excessive estrogen from aromatization, but my endocrinologist refuses to give me any antagonists because the most effective antiaromatase and the favorite of body builders is classified as a breast cancer drug. I had to discontinue testosterone due to increased blood pressure and water gain (estrogen again) and withdrawl was hell. I later found out that bodybuilders solve that problem with Clomid (a FSH/LH raising fertility drug)that helps jump-start endogenous T production.
So, I'm viewing melancholic depression as creating HPA dysregulation with increased cortisol (stress hormone) levels and lower anabolic hormones. This promotes obesity and yet higher estrogen and lower androgens.
The following don't work: Prozac, Paxil, Zoloft, Lithium. Welbutrin gave me flu symptoms, and I could hardly stay awake over a 2 day period after a half tab of Remeron. 20mg of Ritalin in the AM has helped me get to work and sleep(yes!), but not think or remember better. Valium has been pleasant in the evening and aided in getting to sleep. Klonipin was too mild and didn't have the benefit of aiding an occational backache.
I've not tried MAOI's and prefer to take the safe kind - selective and reversable. L-Deprenyl is speedy and only FDA approved for Parkensons. Moclobromide would take a while to order over the internet. At this point, I don't care about the money if I can find long term relief for the dysthymia.
ECT seems really crude, though proven to improve endocrine function. I'd rather use it last.
Tonight I've started Serzone, though my pdoc thinks its one of the less effective meds. I was interested in its side effects of lowering blood presure, not increasing weight or impairing sexual function, and triggering Growth Hormone release (which promotes weight loss). In the AM I will be taking Effexor XR.
I'm not sure this is the best thing to try for the next 6 weeks, or there are drugs that work well for what I feel must be a pretty common form of depression. I was "happy" for a while ignoring the life of dysthymia, but turning 40 has made me realize I've wasted 20 years this way and its time to try again to "solve" the problem. Trying to find a good endocrinologist has been frustrating and more depressing than my baseline - neither one I went to is willing to even try giving me the minute dosages I need to correct excessive estrogen. Fortunately my pdoc is very up on research, shares her experience, and will give me anything I want to try.
I was interested in the talk here about Amatadine because my ACT/ACH liver numbers were somewhat above normal and I've had minor, chronic neck lymph tenderness/swelling. The current endo dismisses it as just fatty liver. I suppose I could ask him what the harm would be of a 2 week course of anti-virals to see if my numbers improve.
Comments? What meds work best for melancholics?
Thanks,
Mark
poster:MarkinBoston
thread:44895
URL: http://www.dr-bob.org/babble/20000905/msgs/44895.html