Posted by AlexCanada on August 17, 2012, at 22:47:58
In reply to Re: Severe Melancholic. My story. Please help., posted by papillon2 on August 16, 2012, at 12:31:16
Hi. Thanks for the suggestions. I have actually tried Lamictal this year. There are few meds I'm sure I forgot to list. Lamictal helped improve my interest a little bit, and it wiped out anxiety really well but it made me feel more stupid than I ever have on any other medication. I could not think clearly in a reasonable manner. Thinking is difficult enough much of the time but it really compounded my thought process. I was even more slowed down and my mind would keep cutting off whenever I'd try to think of something. I could not tolerate such an effect. The ''Lamictal Stupid'' syndrome is well documented online and it's unfortunate that it has such an effect on me.
I am possibly willing to give pristiq a chance because I may not have given effexor enough time. The issue was worsening of dep and anxiety and it was during my darkest days and i probably felt like screaming if the doctors at the hospital had kept me on it. But... with my baseline a bit improved I could perhaps handle such a medication and attempt to give it a decent trial period. I mention Pristiq because articles keep mentioning that it is approved for Melancholic.
I am interested in a possible TCA though.
Ketamine I have researched and unfortunately if it only lasts for 7-10 days then it is not something i'd want to look into just yet but i am glad they are putting new medications into trails which are based upon the ketamine research.
I'm wondering... if Lamictal had some interest restoration and gave some small ability to enjoy things... why would that possibly be? And what might be similar? But I hope without the severe cognitive side effects.
Regarding TCA's... any cognitive side effects do they often go away if they deal with the core melancholic symptoms? So many meds dumb me down but I am already in a very dumbed down state right now. I'm hoping a TCA might be able to restore my cognitive impairment and other issues despite their possible side effects.
What can I expect in terms of TCA's generally? such as maybe clomipramine? I don't remember what happened with nortripline.
> Hi Alex,
>
> I just came online to answer your question (posed in another thread) about what has helped me with my melancholic depression, but it seems that with a couple of exceptions you have tried everything I have and more.
>
> My current regime is:
> Nortriptyline 100mg
> Lamotrigine (Lamictal) 200mg
> Melatonin 4mg to help regulate my disturbed circadian rhythm
> Various supplements and Aspirin to manage Nortriptyline related cardiac issues.
>
> Of these, I see you have not tried Lamictal. I take it to augment my anti-depressant and because studies suggest it can delay episodes of bipolar depression in people with bipolar II. We're hoping it might do the same for unipolar depression.
>
> I'm not fully in remission, so my psychiatrist has been talking about trying Ritalin, Ketamine or rTMS. Ketamine is showing great promise as a treatment for severe and treatment-resistant depression and it may be suitable for you. Here's an article about it if you are up to reading it, otherwise you could print it out to take to your doctor: http://www.psychiatrictimes.com/mdd/content/article/10168/2090154
>
> You mentioned Pristiq. I question whether it would be of any additional benefit to you over Effexor given its similar mechanism of action and the severity of your depression. Many people, like me, find that a broad spectrum anti-depressant such as a TCA or MAOI is necessary for melancholc depression. SSRIs and SNRIs just don't seem to do enough. As Scott has posted, there are other tricyclics you could try beyond Nortriptyline. So that's another thing to consider.
>
> For your memory and cognitive problems, there's a non-medication treatment called cognitive remediation (rehabilitation) therapy. I haven't personally tried it and I don't know anyone who has, but I've been reading good things about it. It might help you manage your symptoms if not improve them.
>
> Layman's description:
> "Cognitive Remediation Therapy (CRT) is a cognitive rehabilitation therapy developed at King's College in London designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved social functioning."
>
> If you do a google search you'll mostly find studies involving schizophrenia patients, but it's also being used in cases of severe depression as well as traumatic brain injury, dementia and anorexia nervosa. So it has a wide range of applications. In a similar vein, I wonder if occupational therapy might also be helpful.
>
> My psychiatrist has been exploring the potential there being a medical problem compounding my depression, making it harder to treat. So far I have been to a sleep specialist, had a sleep study done and consulted a endocrinologist. Next on the list is an immunologist to check for an auto-immune disease as these can cause fatigue and cognitive problems. These might be areas for you to explore should your doctor find it appropriate. I'd definitely get a sleep study done if nothing else. Sleep disorders are renowned for causing fatigue and cognitive problems.
>
> I find lists helpful, so here's a summary of ideas you could raise with your doctor:
> (1) Lamotrigine (Lamictal) to augment your anti-depressant
> (2) Ketamine -- this I suspect would do more for you than
> Lamictal
> (3) A tricyclic anti-depressant other than Nortriptyline
> (3) Cogntive Remediation Therapy or Occupational Therapy
> (4) Seeing other specialists to rule out medical problems which could be compounding your depression, e.g. a sleep disorder.
>
> Your distress and desperation is palpable from your writing. 10 years with severe melancholic depression with very little relief must be gut-wrenchingly brutal. I admire the tenacity and fighter in you. With further treatment options still available (and new ones being developed), I wholeheartedly believe that there is reason for you to continue holding out hope for some relief. So hang in there, Alex, and be kind to yourself.
>
> Papillon
poster:AlexCanada
thread:1023380
URL: http://www.dr-bob.org/babble/20120803/msgs/1023572.html