Posted by SLS on November 29, 2002, at 19:59:29
In reply to Re: Update on hard to treat depression strategies, posted by ItsHowdyDudyTime on November 28, 2002, at 23:08:42
> > Zyprexa (olanzapine) is becoming increasingly recognized as being a potent adjunct for bipolar depression and other treatment-resistant depressions (TRD). I am currently experiencing encouraging results with the following combination:
> >
> > Lamictal 300mg
> > Nardil 90mg
> > Zyprexa 5.0mg
> >
> > Zyprexa has been combined successfully with the SSRIs. In fact, Eli Lilly, the manufacturer of both Prozac and Zyprexa, has combined these drugs into a single preparation and will likely be approved for the indication of bipolar depression and perhaps later for TRD and psychotic depression.
> >
> >
> > - Scott
>
> Scott, zyprexa can be used for type one bipolar without too many troubles. However for unipolar major depression that is TRD, Zyprexa is not a wise choice. Those afflicted with unipolar major depression tend to not have the higher dopamine levels that schizophrenics and classic type one manic depressives have. Thus we cant tolerate even low dose atypical anti-psychotics very well, much less for long time periods.
Howdy-Doody,My viewpoint was similar to yours for quite a while. However, I have seen over the last few years individuals on Psycho-Babble whom had suffered for years with severe TRD, and whom had never exhibited bipolarity, improve markedly upon the addition of Zyprexa to an SSRI. It makes sense to me that it would perhaps be an equally worthwhile addition to MAOIs, which are, among other things, pro-serotonergic. I have seen at least two people with depression respond to Zyprexa monotherapy. It would be a valid argument that the majority diagnosed unipolar depressives whom respond to Zyprexa are actually occult or soft bipolar or otherwise fit within the spectrum of bipolarity.
For some people, TRD means treatment-refractory. They have tried "everything" and remain hideously depressed. Unipolar or not, I think such a desperate condition would warrant alternative treatments, even if they are encumbered with a greater risks of temporary or permanent side-effects. In the past, such situations have caused people to allow medicine to administer things like megadose insulin-shock, electrical current applied to the cranium (ECT), intense intracranial magnetic fields (rTMS), wire leads grafted to the vagus nerve and served with electric pulses (VNS), and even cingulotomy psychosurgery (the removal of brain tissue).
When Zyprexa first came out, and my doctor suggested I try it for depression, I declined. I was very afraid of EPS, especially nearly-irreversible tardive dyskinesia. However, I no longer have that fear. Zyprexa (and Seroquel) have shown practically no potential for producing tardive-dyskinesia, and the rate of other EPS is relative small. At 5.0mg, I hardly know that I'm taking it.
Quite a few studies are emerging demonstrating that antidepressants + Zyprexa are better than Zyprexa alone in TRD, regardless of depressive disorder. As an aside, Zyprexa infrequently induces mania. Zyprexa might very well end up being the first-line drug for bipolar disorder. It acts as a true mood stabilizer along several fronts:
1. antidepressant
2. antimanic
3. reduced number of episodes
4. few somatic side-effects
4. few cognitive side-effects
5. extremely low risk of tardive-dyskinesia
6. once-daily dosing.> Better solutions are needed.
We were born 20 years too early to be cured and 20 years late enough to be availed any solutions at all.
> Drugs which dont cause dopamine blockade and have acceptable side effect profiles. At the moment of this writing, there are really only two effective treatments for unipolar TRD and those are ECT and MAOIs.I know it seems that way sometimes, but my observations of some (very lucky) people yield many successful alternatives, one of which is to simply take a high enough dosage of an antidepressant for a long enough time. This has been my own experience with the few successes I have had.
> Have you ever considered ECT, Scott?Yes. Thanks for asking.
In 1991 (age 31) I was given a series of 15 treatments. The first 8 were unilateral-left, the rest were bilateral. I experienced a small antidepressant response that lasted six hours or so after the fifth treatment. Despite continuing with bilateral treatments, no further improvements emerged. This might mean very little, however. In a series of correspondences with Max Fink, MD, a specialist in ECT, he told me that a great many things have changed since the time of my treatments, and that it would be unwise to conclude that I am not a responder to ECT. It still lingers out there as an alternative for me.
I guess everything boils down to making an informed assessment of benefit versus risk. Although I have chosen to take Zyprexa, like you, I wish there were a more effective, zero-risk alternative.
Thanks for your suggestions and comments.
So many drugs - so many perspectives. So much pain.
I haven't been following PB closely lately, but I hope all is well with you. If not, I hope for you that Hope remains true and intact.
Sincerely,
Scott
poster:SLS
thread:129604
URL: http://www.dr-bob.org/babble/20021127/msgs/129958.html