Posted by PC_Load_Letter on August 6, 2008, at 14:36:25
Hello fellow Comrades in Arms,
Chronic major atypical refractory unipolar depression here (around 20 years now-yikes) with some general anxiety, occasional panic attacks, and sub-clinical OCD thrown in for good measure. I had the VNS implanted around 8 years ago; it finally kicked in around 1.5 years after it was turned on, once the stimulation was raised to a high enough level. Unfortunately, around 6 months after the immediate (from one day to the next) strong response, I lost much, though not all, of the benefit of the VNS.
Since losing the initial great response to the device, I've tried many things, including altering numerous stimulation parameters of the device. This only makes things worse. I've also tried many meds, including several that worked (at least for a while) before the VNS. These either made things immediately much worse (Luvox, desipramine, nortriptyline: it's like they cancel the effect of the device) or pooped out after 2-4 weeks (Nardil, Parnate: these also cause significant worsening of depression after the poop-out, which didn't allow me to continue them). My longest response to any med before VNS was the desipramine, which gave me around a year of good effect.
Let's see...what else...I've tried all the other SSRI's, all the more stimulating tricyclics, clomipramine, Ritalin (immediate worsening of depression), Lamictal, Geodon (immediate and severe tardive dyskinisia), Cymbalta, Remeron, Zyprexa (can't remember if this was in combo with anything), Depakote, Marplan, Emsam, Effexor (actually had a brief response to this a month or so ago, then poop-out, then raised does and experienced severe sedation), Wellbutrin, Effexor, Effexor + Wellbutrin, Provigil, Requip (severe worsening of depression), T3/T4, an incompetent low-dose trial of lithium with no effect that I can remember (my pdoc doesn't think it worth another trial of lithium [or combo], since I'm not bipolar.), Effexor XR (actually had a brief modest response to this a month or so ago, then poop-out, then raised the dose and experienced severe sedation)
I've also tried Ultram (modest 3-4 day response) and an unofficial Vicodin trial (2-3 days of strong response is about all I can get, then poop-out). My doc laughed when I tentatively brought up buprenorphine, so I thought it best not to pursue the matter. It doesn't seem like opioids would be an effective long-term solution for me anyway.
I've also tried numerous vitamins/supplements, including 5-HTP, various B vitamins, SAMe, fish oil (still on this, it helps a bit, I think), vitamin C, years of cognitive/behavioral therapy, steady exercise, healthy eating and sex and rock 'n roll (with a very modest amount of excessive alcohol use and a couple uses of weed as an adult many years ago thrown in for good measure, but no other illegal substance use/abuse). I cannot tolerate alcohol at all these days, as it results in a significant worsening of the depression.
Another factor that might be of interest: though I've never had what could be described as a manic episode, I did have what I, anyway, think may have been brief (2 day-1 week) hypomanic responses to a couple of AD's: (Luvox, first trial) and Effexor + SAMe (non-officially condoned by pdoc combo). I also respond to AD's (if I respond at all, that is) very quickly; within around 1-2 weeks. I've been on several meds and combos longer than that 4 weeks but have never responded to anything after around 2 weeks.
Since my pdoc seems to have run out of ideas, I thought I'd run my conundrum by the brain trust here to see if anyone here can offer any incisive suggestions. I'm thinking Abilify, Deplin, or Imipramine might be worth a try.
I really don't want to do ECT (though I would do both it and DBS, if it comes to that) or even have my amalgams pulled (is there any good evidence to back this up??). I don't want to have to quit my job but am getting very tired of the daily struggle to function.
Thanks in advance for any thoughts/suggestions.
poster:PC_Load_Letter
thread:844599
URL: http://www.dr-bob.org/babble/20080805/msgs/844599.html