Posted by sweetmarie on March 15, 2001, at 12:44:29
In reply to Re: treatment resistant depression - Scott » sweetmarie, posted by SLS on March 14, 2001, at 22:44:38
Scott,
>
>
> > I`m glad to have been of some use. Like you, I can`t afford to rule anything out (if that`s what you were saying).
>
> Yup. That's the story.>
> > I`ve been very severely depressed for about 3 years, with all the stuff that goes with that (inability to work, have a social life, carry on any meaningful relationships with friends, etc.)>
> Yup. I know this story too. I am sorry that you had to tell it.
>> > Nobody in my family has ever been diagnosed with Bipolar Disorder, and it has certainly never been suggested to me that I may have it.
>
> The reason I asked is because you having been taking two "mood-stabilizers", Lamictal (lamotrigine) and Epilim (valproate). This is a strategy that is generally associated with bipolar disorder rather than unipolar major depression. I am very interested to know how critical a role both play in getting you well.I know that both Epilim and Lamotragine are mood stabilisers, and to be quite honest, I`m not entirely sure why I am taking both. As I said, there has never been a hint from any doctor that my condition might be Bipolar. The Epilim replaced Lithium as an `augmentation`, and the Lamotragine was prescribed about 6 months later. The ony reason that I was prescribed Lamotragine was that another of my psychiatrist`s patients had read of it on the Net. She had tried it, and it had worked miracles. So, this is the only basis for me going onto Lamotragine (this previous patient was the first person that my psychiatrist had ever used Lamotragine with). Although my consultant psychiatrist is very good at her job (and I both like and trust her), she only has limited knowledge of resistant depression, and I have proved to be a very difficult case. I think basically, she was clutching at straws, and this combination (Epilim, Lamotragine, Trimipramine and Phenelzine) was more of a `mish-mash` than anything else. It was when this failed to work that she referred me to the specialist (who has subsequently assessed me, given me a diagnosis, and I will be under his care when I go into his hospital - not my local one - in about a months time. I guess that this answers your question about the Epilim/Lactimal combination (i.e. it didn`t help me at all, but a) I was on a very small dose of Lactimal (25 mg, which will now be going up to 250 mg), and b) these treatments are very individual (what didn`t work for me, may work for you).
>
> > The only other person I know of who suffers at all from depression is my sister, who gets mild depression for short periods, and are adequately treated with a short course of anti-depressants. Her low moods are `reactive` though, unlike my illness which is genetically based,
>
> Just for the sake of extending understanding, and not as an attempt at diagnosis, all of the features you described above can be symptoms of a "soft" bipolar presentation. My sister has followed exactly the same scenario, her bipolarity being evidenced by a hypomania induced by Nardil, an MAO-inhibitor antidepressant. Bipolar disorders are extremely heritable (genetic) and very often appear among siblings, although not necessarily to the same degree.
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> > and I`ve suffered to differing degrees (from moderate to severe) most of my life.
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> I get pissed whenever I have to read a story like yours. Damn it.Is that because you`ve had a similar experience? From what you`ve said, it sounds like it.
>
> > She has a very stressful job - she`s a psychiatric nurse (enough said, probably).
>
> Again, for the sake of understanding, stress can precipitate an episode of an otherwise dormant bipolar illness. This also true of many other mental illnesses. A mild episode can remit spontaneously if the stress is removed or mitigated. I have seen this happen with my sister over the last six months. Thus, episodic mild depressions are no less facilitated via a genetic terrain than are chronic and severe presentations.The problem here is that I know for a fact that my sister would in no way welcome any queries as to her mental health. I have asked in the past, but she keeps this kind of thing very much to herself. >
> > Re. discontinuing Nardil in order to start on Venlafaxine, you`re right - there should be a certain gap (about a week, I believe) before Venlafaxine can be commenced. Having said that, a friend of mine has just cganged from Nardil to Vanlafaxine, and her psychiatrist has overlapped the two. I don`t think that she`s suffered any side effects from this - apart from the severe depression she has been experiencing for slightly longer than me (we are quite a comfort to each other). This isn`t the `correct` way to do it, I`m sure though.
>
> All I can say is that I know of no way to confidently predict which people will experience a life-threatening reaction to such a combination and which will not. Once upon a time, in an act of desperation, I decided to take a nibble off a small piece of venlafaxine (Effexor) to see how it would react with the Parnate I was taking. Within ten or fifteen minutes, I experienced vertigo and I had to lay down. I couldn't get myself to sit up in bed. I became incoherent and hardly knew where I was. I made no sense at all when speaking to my parents. I told them not to worry about me, that I understood what I did wrong, and that I simply had to reboot the system. No problem.> > I can't emphasize enough what a tiny amount of Effexor I bit off. Because of its short half-life, I chose Effexor purposely to test for the potential of developing serotonin syndrome when combining a serotonin reuptake inhibitor with an MAOI. If something went wrong, it should dissipate relatively quickly. It did. So did my notions of trying it ever again.
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> > Good luck with the Trimpramine (if you choose to take it).
>
> > How long have you been depressed?
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> With the exception of a 6-month remission brought about by a combination of antidepressants, 24 years.What happened after the 6 month remission - did you discontinue the treatment, or did the effect simply wear off? 24 years is a long time - has it been severe ALL that time? How old are you? Mind you, I don`t really remember a time when I wasn`t depressed, and I`m 34 now.
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> > Is it moderate/severe?
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> Severe. (I have been accused of being overly proud of this).
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> It was an honor to be assessed as being the most severely depressed research patient enrolled at the NIH during my nine-month stay there. Although there was this one guy who was an ultra rapid-cycler whose depressed state during the first three to six hours following a switch into his depressive phase seemed worse than mine. I envied him, though. After three days of depression, he would swing into a controllable hypomania that would last for eight. Gosh, what I could accomplish in eight days out of every eleven...What do your psych doctors say about your situation? Do they encourage you and say that there will be a `right medication` or `right` combination? Are they sympathetic? How long have you been on medication treatment? (I have been on different things for the past 10 years now. Only the very first anti-depressant I ever had worked; that was Dothiepin, which I took for a year and I was 100% well. So well in fact that I stopped taking it, and when the symptoms returned I went back onto it. It didn`t work 2nd time around, and I have been kicking myself ever since for coming off it in the first place). Have you tried ECT? I had 20 sessions during one hospital stay, and it did sod-all to improve my mood. What it did do though, was to totally wipe out my memory of the previous 18 months. Terrific. And what about a specialist - have you ever been referred? Have you asked?
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> > Whatever, you have all my sympathy - it is truly a hideous illness.
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> Yup.
>
Well, keep on keeping on (as they say),
>
Anna.
poster:sweetmarie
thread:55847
URL: http://www.dr-bob.org/babble/20010310/msgs/56584.html