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Getting serious with my new doctor - what to ask

Posted by violetdream on May 28, 2012, at 4:43:58

tldr alert, background!

Ok, so I have severe (what I think is) atypical treatment resistant depression, as well as general anxiety and Asperger's. I've suffered from crippling rejection sensitivity as well as mild BDD recently as well as symptoms of conversion disorder such as hysterical paralysis and transient aphasia during extreme stress. Very very rarely I will have mini manic/hypomanic episodes with uncontrollable laughter and then crash very badly after, but it's 99.999% the depression. I don't have OCD as such but I've had trichotillomania since I was very young as well as obsessive thoughts/rumination.

I've tried meds in probably every class with such a broad spectrum of symptoms that I was once labeled as mood disorder NOS. At a very early age I started low doses of anti-psychotics, which seemed to be the only thing that would barely touch my depression.

Anyway, things got worse and worse and working with my family we started to get more aggressive, I did a round of TMS (nothing) and then finally 20 bilateral sessions of ECT (nothing but gave me retrograde amnesia). However at this time I started the Emsam patch. It seemed to be working quickly and very well (infuriatingly MAOIs were the one thing I hadn't tried!) but it didn't quite do it for me so I decided to switch to Parnate. I was able, with the help of an incompetent doctor, get to 60mg, and now that I've found someone new I want to talk seriously about additional tests and possible augmentation I can do. I've been on 60mg of the Parnate for maybe a month and a half now and things haven't changed much, in fact have gotten a bit worse.

I'm looking to rule out any hidden medical causes of my depression. The only thing I have not done is have a comprehensive panel of many different specific tests. However, as I have had symptoms since puberty, there must be a genetic basis, but things have gotten so bad lately I feel something must be going on.

Things I've done: I had an MRI last year, everything checked out. I got some blood tests done, showing a depletion in Vitamin D. I've since raised that to acceptable levels and along the way made sure to dose up on B vitamins. I'm in the process of raising my iron levels, they're within normal, but on the low side. I had a metabolic panel done and potassium looked great, which I was relieved by.

Things I haven't done: I got some kind of thyroid test, but not a comprehensive one, quite a while ago. Here are some physical symptoms I have that I'm wondering would contribute to the depression that, as far as I know, doctors have never looked into thoroughly.
1. Chronic tachycardia (some kind of thyroid issue?) I am *always* running around at least 100bpm with no activity/stress.
2. Possible PCOS, non diagnosed, but I've had such awful dysmenorrhea that I've been on continuous birth control most of my life (I've never noticed any mood changes when going off, though), as well as hard to control acne and metabolic syndrome (very high cholesterol since I was too young to have it be due to food).
3. This one may be out here, but I was wondering about the use of medications that may possibly treat any neurotoxins and help with the ECT memory loss? I was thinking about this after I saw that minocycline had strong anti-inflammatory effects and passes the blood brain barrier. I'm not sure offhand of any "amnesia meds" but I know there must be something, and I've had cats long enough that I'm sure I have latent toxoplasmosis by now (which in one study was shown, while being associated with increased intelligence, was also associated with susceptibility to guilt and anxiety in women.)
4. Limb weakness, started intermittently around January - at times I feel like I've run a marathon just going up the stairs or walking to the bathroom! It comes and goes and it's too vague for me to figure out, but I am still working on the iron supplements.

Can anyone think of some fun augmentation strategies for either now or the future, given these symptoms, or just in general, when I've titrated up to something more like 90mg of the Parnate? I know that I've seen some interesting ones with Parnate but you'd need a good doctor to approve them. I really want to get serious with my doc this time and leave no stone unturned...I am seriously at the end of my options here, if this doesn't work :( Thanks for your help! <3




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