Posted by steve on March 9, 2001, at 15:33:03
In reply to Re: treatment resistant depression » sweetmarie, posted by JahL on March 9, 2001, at 13:03:13
Are you a melancholic depressive (ie no appetite, no sleep and agitation) or an atypical one (ie sleeping all the time, overeating and feeling just tired.)
If you are the former, meds like nardil etc could very well be making things worse and not better.
The two different forms of depression have opposite symptoms and functional imaging studies have shown that in one form of depression some areas are underactivated and in the other one the same areas are overactivated.
This begs the question how the same medicine is good for both manifestations. The answer is that meds seem to cause structural changes to the brain that usually allow melancholics to lead a normal life, and at the same time cause other changes which give atypicals their oomph.
However, and I think this a terrible blot on psychiatry, which I consider the most corrupted part of medicine, some can't handle the energizing properties of the SSRIs, and actually do worse on them, as my Yale educated doctor told me. Dr. Cole at Harvard estimates that roughly one out of every two hundred depressives becomes severely agitated on the SSRIs, and I would wager that there are even more people who don't go nuts, but become more depressed on them. And of course most idiot shrinks, going purely by what they learn at the symposia sponsored by pharma companies, conclude that their patients are doing worse despite, and not because of, their medicines. This in turn leads them to add more medicines, making the sitation even worse. According to my doc, the best one can do for melancholics who worsen on ssris is to take them off SSRIs and go with lamotrigine monotherapy.
Since I've just once again harped on how corrupted psychiatry has become, maybe I should give an example. When their were concerns that Prozac, which is known for giving tired depressives a "boost" might be making agitateted depressives even more anxious, perhaps to the point of becoming psychotic, Eli Lilly hired Dr. Martin Keller to 'study' the matter. Later on it emerged that Lilly and others had paid Keller $500,000 without it being reported. I think justice would have required that he be stripped of his professorship at the very least, and his medical license probably as well. Instead the only repercussion of his blatantly unethical conduct was that he was barred from giving presentations at the APA. Another barely known factoid is that the FDA seriously considered making Lilly include a warning in its Prozac information leaflet saying that Prozac had been found to worsen many forms of depression. For reasons that are somewhat opaque to me, they decided that such a warning would be too 'complicated.' Face it sports fans, the only focus of the industry is to sell their product. If it gets you well that's good, if not, or it worsens your condition, that's your problem.
> > I suffer from (severe chronic `double`) depression, which has proved VERY difficult to treat (I`ve had Tricyclics, SSRIs, an MAOI (Nardil), ECT, Maclobomide, Reboxetine, L-Tryptophan, Venlafaxine, and different permutations. I am currently on Nardil, Trimipramine, Lamotragine and Epilim to no effect). I`ve been referred to a specialist in `difficult to treat depression`, who plans to put me onto Venlafaxine, Mirtazapine and increase the dose of Lamotragine. I don`t really know why I am posting this message; I guess that I was wondering whether anyone else out there has had similar difficulties (I have been going through a major depressive episode for the past 6/7 years now, which has been severe over the past 3. Has anyone `been` where I am now? Any success stories? Or even partial success stories? I am very ill at the minute, and feel extremely hopeless - something which grows more with every treatment failure. I have had different kinds of `talking` therapy over the past 9 years, and hope to be well enough at some stage to do CBT. Can anyone help?
>
> Hi there.
> Like yourself I'm UK with treatment-resistant double depression (+ADD+social phobia...). I've had high-dose trials of all the meds you mention, & many more besides. All w/out significant success...that was until I started Lamotrigine just over 2 wks ago. I'm only just up to 37.5mg but already the improvement has been dramatic (see 'BIPOLAR EXPERT' thread 4 details).
>
> At yr current 25mg dose I can almost *guarantee* (tho' definitely no expert) you won't feel significant remission of yr depression. The proposed 250mg will give Lamotrigine scope to work it's magic (I'm biased).
>
> You are fortunate to have found such a forward-thinking UK pdoc-I can't even find one to prescribe Lamotr. monotherapy, let alone such 'power combos'. I have to order mine from abroad (tut,tut,eh steve?). It's just a shame you have to reside in hospital.
>
> I have high hopes for the Lamotrigine (which has the most anti-depressive profile of the mood-stabilizers); you may even find the Venlafaxine+Mirtazapine become/are redundant! Your doc sounds like he knows what he's doing.
>
> Good Luck,
> Jah.
poster:steve
thread:55847
URL: http://www.dr-bob.org/babble/20010302/msgs/56020.html