Posted by SLS on July 20, 2003, at 20:34:40
In reply to need advice on transient response to meds, posted by Craig Allen on July 20, 2003, at 16:41:17
> i'm an atypical depression, possible bipolar II, as a lot of us appear to be on this board. i've gotten a very good and very brief response to different drugs over the last several months. my one constant is effexor xr 300mg daily. i get some help from it, not nearly enough. i was started on abilify a few months back - felt great for about a week, then nothing. i messed with the dose but i couldn't get any response. same story for seroquel. 4 great days, then nothing. increased and decreased the dose, still nothing. last week, i was started on lithium 600mg daily. again a much improved mood for 3 days, then nothing. i'm still on it, but based on this frustrating history of transient response, i'm not hopeful. anyone else have experiences like these?
Dear Craig,Your situation sounds very close to my own. Doctors have been banging their heads against the wall trying to get me well for over 20 years.
Briefly:
- Tricyclics: great response after 2 weeks that lasts for exactly 3 days.
- Tricyclic discontinuation: rebound improvement lasting 2 weeks
- Parnate: moderate response after 10 days that lasts for 3 days; sometimes precipitates severe mixed-state mania when combined with tricyclics
- Nardil: moderate to robust response after 10 days that lasts for a few days to several weeks.
- Nardil discontinuation: rebound severe mania
- Nomifensine (Merital): great response after 2 weeks lasting for exactly 3 days
- Effexor: initial good response that faded after a few weeks; thereafter a mild improvement at 300mg
* The best response I ever had was to a combination of Parnate 60mg + desipramine 150mg
I am currently taking:
- lamotrigine (Lamictal) 200mg
- imipramine (Tofranil) 300mg
- atomoxetine (Strattera) 80mg
- aripiprazole (Abilify) 10mgIt is still very early, but I have begun to respond to this combination upon the addition of atomoxetine 3 weeks ago. I remain hopeful, but am trying not to get too optimistic. It is difficult, though. I tend to be a constructive optimist. I guess it's a character flaw. :-)
I have tried over 50 drugs in various combinations since I was first diagnosed 21 years ago. At times, I have lost hope, only to have it come back and find me. I wish I could impart to you the hope that has kept me going for so long. I have always managed to find some treatment alternative that I had not yet tried, whether it be a new drug, an old drug being used in a new way, or permutations of drugs that I have already tried in different combinations. It is simple logic. Hope is probably there for you if you are willing to look for it. It should be. I doubt that you have tried as many treatment regimes as I have, including ECT. Of course, this is easy for me to say today, Sunday, July 20, 2003 at 9:21 PM because I am feeling better. If things continue as they are, I will be living proof that it is most likely that there is an answer for you as well. Sorry for the Pollyanna stuff. It's real, though.
Patrick McGrath, MD, at Columbia University put it so well to me several years ago: "For every new drug that comes to market, a certain percentage of previously treatment-resistant people will respond to it."
Believe.
Look for duloxetine (Cymbalta) before the end of the year.
Good luck.
- Scott
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Drugs that have demonstrated partial responses:- amitriptyline (Elavil)
- amphetamine (Dexedrine)
- aripiprazole (Abilify)
- bromocriptine (Parlodel)
- desipramine (Norpramin)
- imipramine (Tofranil)
- lamotrigine (Lamictal)
- nomifensine (Merital)
- nortriptyline (Pamelor)
- olanzapine (Zyprexa)
- paroxetine (Paxil)
- phenylzine (Nardil)
- risperidone (Risperdal)
- T4 (Synthroid)
- tranylcypromine (Parnate)
- venlafaxine Effexor
- viqualine
- ziprasidone (Geodon)Drugs that have made my depression substantially worse:
- bupropion (Wellbutrin)
- amoxapine (Ascendin)
- modafinil (Provigil)
- moclobemide (Manerix)
- protriptyline (Vivactil)
- lithium
- valproate (Depakote)
- T3 (Cytomel)
- reboxetine (Edronax)
- mirtazapine (Remeron)
poster:SLS
thread:243709
URL: http://www.dr-bob.org/babble/20030718/msgs/243747.html