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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 58 to 82 of 133. Go back in thread:
Posted by dove on March 22, 2001, at 11:22:10
In reply to Re: treatment resistant depre Scot, Sweetmarie » SLS, posted by sweetmarie on March 20, 2001, at 14:52:08
>
>I asked hime about the combination that my specialist is putting me onto (Venlafaxine, Mirtazapine and Lamotragine). I just wanted to know whether it was a commonly used combination >in severe resistant >cases like mine.
>There IS help, even if you are losing hope. There have been so many hurting people that have passed through the Psycho-babble door, entering... exiting... some leave well, some do not. We meet people and we share the strategies and the weaponry in order to fight the battle, and hopefully win the war.
Many of us have taken and/or are taking "med cocktails" that may include over 10 different medications. Currently, I'm taking six different meds per day, and yes it can be a pain, but at least I can get up in the morning, smile (and sometimes laugh) with my kids, and I can see a light--not piercingly bright like a searchlight--nevertheless, a light at the end of the tunnel.
I've been fighting depression for nearly 20 years, since childhood, and I've seen those dark corners and I've counted the bricks, waiting and waiting.... For what? For a break in the cycle, for a breath of life-imbuing air, for a victory. And I've won those victories, though they seem less of a victory than merely a reprieve in the glaring light of the bloody battle.
But with each victory I gain another medal, another "win", and I though I must keep fighting, there are respites, of rest and restoration (my own definition of R&R&R). Keep searching for the quickly passing moments of peace, joy or laughter, try not to forget them, they have the power to embolden you and the strength to smack the beast of depression across the side of the head, even if momentarily. The beast will not win. Keep looking for those little holes in beast's dark hide and try to pierce through that tough skin, even for a few minutes, every reprieve should be counted as a victory, really!!!
In no way am I trying to make your pain appear *less* than it is, we hold your journey back to life, love, liberty and health in highest regard. I'm not giving you any concrete advice meds-wise per se, and my message may better suit the Psycho-Social-board but I really want to express to you that there are many more lighthouses on the horizon. They are sounding their foghorns and their revolving beacon awaits your discovery. And if all else fails... Come back here and keep on talking, we are listening!
I'll keep you in my thoughts and prayers,
dove
Posted by sweetmarie on March 22, 2001, at 14:23:29
In reply to Re: treatment resistant depre, Sweetmarie, posted by dove on March 22, 2001, at 11:22:10
> >
> >I asked hime about the combination that my specialist is putting me onto (Venlafaxine, Mirtazapine and Lamotragine). I just wanted to know whether it was a commonly used combination >in severe resistant >cases like mine.
> >
>
> There IS help, even if you are losing hope. There have been so many hurting people that have passed through the Psycho-babble door, entering... exiting... some leave well, some do not. We meet people and we share the strategies and the weaponry in order to fight the battle, and hopefully win the war.
>
> Many of us have taken and/or are taking "med cocktails" that may include over 10 different medications. Currently, I'm taking six different meds per day, and yes it can be a pain, but at least I can get up in the morning, smile (and sometimes laugh) with my kids, and I can see a light--not piercingly bright like a searchlight--nevertheless, a light at the end of the tunnel.
>
> I've been fighting depression for nearly 20 years, since childhood, and I've seen those dark corners and I've counted the bricks, waiting and waiting.... For what? For a break in the cycle, for a breath of life-imbuing air, for a victory. And I've won those victories, though they seem less of a victory than merely a reprieve in the glaring light of the bloody battle.
>
> But with each victory I gain another medal, another "win", and I though I must keep fighting, there are respites, of rest and restoration (my own definition of R&R&R). Keep searching for the quickly passing moments of peace, joy or laughter, try not to forget them, they have the power to embolden you and the strength to smack the beast of depression across the side of the head, even if momentarily. The beast will not win. Keep looking for those little holes in beast's dark hide and try to pierce through that tough skin, even for a few minutes, every reprieve should be counted as a victory, really!!!
>
> In no way am I trying to make your pain appear *less* than it is, we hold your journey back to life, love, liberty and health in highest regard. I'm not giving you any concrete advice meds-wise per se, and my message may better suit the Psycho-Social-board but I really want to express to you that there are many more lighthouses on the horizon. They are sounding their foghorns and their revolving beacon awaits your discovery. And if all else fails... Come back here and keep on talking, we are listening!
>
> I'll keep you in my thoughts and prayers,
>
> dove
Dear dove,Thank you for your response to my message. People on this board have been SO good to me ... I don`t really think that I merit such attention. But I certainly welcome it. I`m sorry to hear that you have been poorly for such a long time - I can definitely relate to that. I have been questioning whether or not I should go into hospital at all to receive treatment from this specialist. This is mainly because I don`t know whether I can cope with another knock-back; I`ve been in hospital 3 times already, and each time I was told that I would get better. This didn`t happen on any of the occasions, and I have been left with the same severe depression which totally debilitates and immobilises me. I`m afraid of finding out that I am `incurable` if you see what I mean. This probably sounds like warped logic, I know, but ... well I`m just frightened. I`ve been receiving medication treatment for 10 years now, and none except the first helped (I took this - Dothiepin - for a year, believed myself well, and I WAS well - I`d never felt like that before in my whole life. Having discontinued it, I immediately felt terrible, went back onto it and it failed to work). Since then, nothing has had any effect and my good times are just a few minutes every week (if that). I know that I will go into hospital, because what else is there for me? I just don`t want to reach the `end of the line` and find myself still as ill. Negative thinking, I know. I also know that you are right, this monster cannot win. The only other option is to `exit stage left`, and I know for a fact that I won`t do that.
How long have you been trying medications? Has this combination improved your life significantly (i.e. are you able to function/see friends/go out etc? That`s all I`m asking of a medication really. The rest I can tackle myself (relationships, work, whatever).
Anyway, thanks again for your kind words.
Anna.
Posted by sweetmarie on March 22, 2001, at 14:43:50
In reply to Re: treatment resistant depre Scot, Sweetmarie, posted by Lorraine on March 20, 2001, at 20:52:47
> {There were a couple of people on the last ward I was in, who had been there over a year, and since his (specialist) plan is to keep me `in` until I`m better, I have visions of becoming one of those saddoes.}
>
> How long does you pdoc tend to keep people in? What's the average?I honestly don`t know, as I have never been treated by this geezer before. He isn`t my regular psychiatrist - he`s a specialist that I have been referred to by my regular psychiatrist.
I suspect he wants this so that he can treat you aggressively, changing meds frequently and monitoring the side effects.
Yes, I imagine you`re right. Also, experience has shown that major drug changes can leave me practically catatonic, which neither myself nor my family (esp my family) can cope with. They are my main carers, and find it very heavy going and stressful, especially as it` been going on for so long.
When people suggest to me that I just "accept" my illness ("So, OK, you can't leave the house. Well, is there a way for you to get comfortable with that and just accept those limitations?") I grit my teeth, then I smile and say sweetly "that's not an option". My depression is hybernation and if I go there and just sit with it for a while it is brain death, slowly but surely all of the lights in my brain go out one by one. So for me there is no other option but to fight the disease everyday whether I feel "optimistic" or not. I fight because there is no other alternative.I know exactly what you mean. People have suggested that I accept the way that I am, and live my life around it. As you said, this simply is not an option. I have virtually no contact with friends (and haven`t had for over 3 years), I have no social life, I rarely get out of the flat, and frankly this is not acceptable to me. Up until 3 years ago I worked, which was a daily struggle, but I managed it by the skin of my teeth. It`s been said to me `well, you used to work`, or `you used to get out and socialise`. This is certainly true, but it all felt like climbing Mount Everest in bare feet and carrying a 10 ton back-pack. I`d put on my `mask`, act as though I was perfectly O.K., and I pulled it off very well. Inside, however, I was totally crippled with pain and used to get home, fall on my bed and just cry and cry. The pain now is unbearable, and just hideous. But, like you, I keep on going (despite my protestations to the contrary), and will continue to do so. I must have some resolve there somewhere even though I don`t feel it. This specialist reckons on getting me well in about a `year or so` (quote). I only wish I could believe that. But I know that I`ll try, because as you said, there really is no alternative (well, there is one, but I`m certainly NOT going there).
All good things,
Anna.
Posted by sweetmarie on March 23, 2001, at 4:35:21
In reply to Re: treatment resistant depression » sweetmarie, posted by JahL on March 9, 2001, at 13:03:13
> > I suffer from (severe chronic `double`) depression, which has proved VERY difficult to treat (I`ve had Tricyclics, SSRIs, an MAOI (Nardil), ECT, Maclobomide, Reboxetine, L-Tryptophan, Venlafaxine, and different permutations. I am currently on Nardil, Trimipramine, Lamotragine and Epilim to no effect). I`ve been referred to a specialist in `difficult to treat depression`, who plans to put me onto Venlafaxine, Mirtazapine and increase the dose of Lamotragine. I don`t really know why I am posting this message; I guess that I was wondering whether anyone else out there has had similar difficulties (I have been going through a major depressive episode for the past 6/7 years now, which has been severe over the past 3. Has anyone `been` where I am now? Any success stories? Or even partial success stories? I am very ill at the minute, and feel extremely hopeless - something which grows more with every treatment failure. I have had different kinds of `talking` therapy over the past 9 years, and hope to be well enough at some stage to do CBT. Can anyone help?
>
> Hi there.
> Like yourself I'm UK with treatment-resistant double depression (+ADD+social phobia...). I've had high-dose trials of all the meds you mention, & many more besides. All w/out significant success...that was until I started Lamotrigine just over 2 wks ago. I'm only just up to 37.5mg but already the improvement has been dramatic (see 'BIPOLAR EXPERT' thread 4 details).
>
> At yr current 25mg dose I can almost *guarantee* (tho' definitely no expert) you won't feel significant remission of yr depression. The proposed 250mg will give Lamotrigine scope to work it's magic (I'm biased).
>
> You are fortunate to have found such a forward-thinking UK pdoc-I can't even find one to prescribe Lamotr. monotherapy, let alone such 'power combos'. I have to order mine from abroad (tut,tut,eh steve?). It's just a shame you have to reside in hospital.
>
> I have high hopes for the Lamotrigine (which has the most anti-depressive profile of the mood-stabilizers); you may even find the Venlafaxine+Mirtazapine become/are redundant! Your doc sounds like he knows what he's doing.
>
> Good Luck,
> Jah.Jah,
I`m sorry to bug you. You mentioned Lactimal working it`s `magic` - does this mean that it has had an effect, or just that you are expecting it to?
I am now on 200 mg (since March 18th - 6 days now), and so far I don`t feel a thing. Do you reckon it`s too early to know? The intended dose that I`m aiming for is 250 mg, but I`m leaving that until I go into Hospital in 3 weeks or so. Am I being impatient? (I expect I am, only I`m just so ill).
Again, sorry to hassle you (you don`t have to answer this if you don`t want to).
Cheers,
Anna.
Posted by JahL on March 23, 2001, at 11:47:53
In reply to Re: treatment resistant depression » JahL, posted by sweetmarie on March 23, 2001, at 4:35:21
> > > I've had high-dose trials of all the meds you mention, & many more besides. All w/out significant success...that was until I started Lamotrigine just over 2 wks ago. I'm only just up to 37.5mg but already the improvement has been dramatic (see 'BIPOLAR EXPERT' thread 4 details).
> > >At yr current 25mg dose I can almost *guarantee* (tho' definitely no expert) you won't feel significant remission of yr depression. The proposed 250mg will give Lamotrigine scope to work it's magic (I'm biased).
> > >You are fortunate to have found such a forward-thinking UK pdoc-I can't even find one to prescribe Lamotr. monotherapy, let alone such 'power combos'. I have to order mine from abroad (tut,tut,eh steve?). It's just a shame you have to reside in hospital.
> > >I have high hopes for the Lamotrigine (which has the most anti-depressive profile of the mood-stabilizers); you may even find the Venlafaxine+Mirtazapine become/are redundant!
> I`m sorry to bug you. You mentioned Lactimal working it`s `magic` - does this mean that it has had an effect, or just that you are expecting it to?HI Anna.
The 'magic' I speak of refers to sporadic rpts I have read of Lamotrigine vanquishing resistant depression where all else had failed. Of course these give no guarantee.
I'm only on 67.5mg but already there are robust improvements in cognition, co-ordination & social phobia. No great improvement in mood but that generally requires higher doses (which I'm building up to).
> I am now on 200 mg (since March 18th - 6 days now), and so far I don`t feel a thing. Do you reckon it`s too early to know? The intended dose that I`m aiming for is 250 mg, but I`m leaving that until I go into Hospital in 3 weeks or so. Am I being impatient? (I expect I am, only I`m just so ill).If you're impatient then so am I; this cautious upwards titration goes against my nature.
250 sounds like a good dose if it's the only anti-convulsant you're taking. I have read that for some a *month+* @ therapeutic doses is required for a response. I think there's a lot of guesswork involved since Lamotrigine's use in mood disorders is a fairly recent development.
> Again, sorry to hassle you (you don`t have to answer this if you don`t want to).
No worries!
J.
Posted by judy1 on March 23, 2001, at 12:44:29
In reply to Re: treatment resistant depression-Lamictal » sweetmarie, posted by JahL on March 23, 2001, at 11:47:53
I've probably written this before, if so please forgive me. The STEP-BD group I am working with have said they have had their greatest success with lamictal in the 200-400mg range (as monotherapy)in bipolar depression and stabilization for treatment resistant rapid cyclers. They are about to publish their findings. When I told the treating psychiatrist that I had a manic episode at 125mg- his response was I was not on a high enough dose. I am now on 100mg, still very depressed but agitated which we attributed to the risperdal I was taking. (Also on 5mg xanax and 6mg klonopin- you would think I'd be comatose). Anyway I am jumping at 25mg increments (no rashes but some dizziness- if that continues I'll drop to 12.5 increments. I hope all of you see some improvement soon. take care, judy
Posted by JahL on March 23, 2001, at 13:04:50
In reply to Re: treatment resistant depression-Lamictal » JahL, posted by judy1 on March 23, 2001, at 12:44:29
> >. I am now on 100mg, still very depressed but agitated
Me too.
> >which we attributed to the risperdal I was taking. (Also on 5mg xanax and 6mg klonopin- you would think I'd be comatose). Anyway I am jumping at 25mg increments (no rashes but some dizziness- if that continues I'll drop to 12.5 increments. I hope all of you see some improvement soon. take care, judy
Hi Judy.
Just a quickie-is that 25mg *per week* ?
Thanx,
J.
Posted by judy1 on March 23, 2001, at 15:09:40
In reply to Re: Lamictal » judy1, posted by JahL on March 23, 2001, at 13:04:50
Hi,
Yes, 25mg/week- but I see him every week. take care, judy
Posted by dove on March 24, 2001, at 15:26:18
In reply to Re: treatment resistant depre, Sweetmarie » dove, posted by sweetmarie on March 22, 2001, at 14:23:29
>
How long have you been trying medications? Has this combination improved your life significantly (i.e. are you able to function/see friends/go out etc? That`s all I`m asking of a medication really. The rest I can tackle myself (relationships, work, whatever).
>I spent much of my childhood and teen-age years self-medicating, except for a stint on Tegretol (AED). I wasn't even prescribed the Tegretol for a mood-disorder but for my fainting/blackout episodes, labeling them seizures. I told doctors that I had depression, and they told me I needed more sunshine (which, looking back, was partially true), and I needed to eat better, needed to gain some weight (wish I had that problem still ;-) needed more vitamin C, more exercise, ect... I also had blinding migraines, still do; however, I now use preventative meds. And it was through my search for migraine relief (and making sure I wasn't having little strokes because I would "faint" or black-out before they came on) that I tried my first med that opened my eyes to an entirely new world that I had only dreamt of.
I was prescribed Verapamil, a calcium-channel blocker used for heart-disease and treating migraines. It was like an OD on beautiful shiny reality, and I was flying. When they felt it was effecting the way my heart beats and causing me to gain weight they moved me to Amitriptyline. The Ami does quell my migraines but I fell into a deep depression after the Verapamil was removed. I kept telling my Internal Medicine Doc, and my other non-specialist doc's that I was depressed and had lost that feeling of being "normal". They all said it would take some time to feel the effects of Amitriptyline and that it was "after-all" an antidepressant!
But I've never been that stable again, nor has the world been that beautiful, alive and real again. I finally received a referral and the permission to see a psych-doc, who dxed me with (in order of importance by his criteria): ADHD, OCD, GAD, Panic Disorder, PTSD, and Rapid Cycling Bi-polar, and I may have forgotten a few. Over time, with different doc's and different dxes, multiple therapists and multiple med trials, I've come to the point where the meds are kind of like a life-preserver in a raging sea, and I have to do some legwork myself to push that life-preserver back to safety. I also know that some meds try to drown me, while others keep me afloat; and that it's really hard to distinguish between the two when you're taking multiple meds.
I have lost contact with all but my very best friend, who lives so far away that we rarely see each other but do talk on the phone every other month or so. I have been bound to the house for some time now, well over five years really. That is, until quite recently. A combination of events and med additions within the last 3-4 months have given me a little more strength, still not what my husband wants to see, but a major step for me.
The primary med that started a slow change and some improvement is Neurontin, and then the addition of Klonopin, and then the addition of low-dose Prozac.
The primary events are my Mom being dxed with Lymphoma and Thyroid cancer, missing my best friend's (who lives far away) marriage this past December and subsequently her Dad being dxed with Leukemia and throat cancer, my childhood and beloved Minister's sudden death at the age of 46, my Aunt's attempted suicide (resulting in hospitalization, ECT, and subsequent recovery); then my eldest son's Grandpa being dxed with cancer in the form of an inoperative and terminal brain tumor (who has a mere three weeks left even though there were no symptoms until last week.), and his Great Grandpa being dxed with Alzheimer's.
So, I still don't want to go outside, or anywhere else, but I do feel more alive. I believe I'm still in the detached-unreality part of real comprehension of the losses. I cried and cried after learning of all and each illness and death, then I became settled enough to speak about these events without falling apart, but deep down there's a lot of fear. I've been writing at P-Babble for over three (1998?) years now, and my presence has been sporadic for the last year or so. I fear writing because all these things and more are wrapped around each other in my heart, soul and mind; and I can't seem to open up without everything surfacing and baring just a little too much flesh, and I then feel vulnerable and overwhelmed resulting in withdrawal once again.
So, after my longgggg sob-story, I think there are meds that can help anyone and everyone at least a little, but it can be a tough journey finding them. Are you struggling with major (double?) depression and one of the anxiety/panic disorders (i.e. agoraphobia)? There are some extremely wise and intelligent, as well as beautiful and kind, people on this board; who share their med/chemical knowledge freely. Sometimes the meds that are "suppose to do the job" don't, and ones that aren't suppose to do the job do indeed do the job.
I'd also be afraid of being in-patient, I was almost committed against my will in December 1999 and I totally freaked. However, if there really wasn't anything but darkness inside of me, and I was really near the end of no turning back, and I had a family whom I loved and who loved me; I would probably check myself in. Remember, there are different strategies and different "experts" all over the world, and though you may feel *this* expert is your last hope, it isn't! I promise you it isn't.
My latest p-doc (also honored with the title "expert") has me taking Adderall, Serzone, Neurontin, Klonopin, Prozac, and Amitriptyline. The combo becomes a little complicated when trying to take 6-8 Neurontin Caplets, 4 Adderall tabs, 4 Serzone Tabs, 3 Klonopin miniature tabs, ect... but the combo is having some beneficial effect, a might bit slow, but better than no!
Don't lose hope, that is probably one of the most important things you need to hold onto, even though it's probably the hardest; after-all, isn't depression all about losing hope. My prayers, thoughts, and hope are with you. I may not post all that often, but I still read, and my eyes and ears will be vigilantly with you on your journey.
dove
Posted by sweetmarie on March 24, 2001, at 18:23:36
In reply to Re: treatment resistant depre, [LONG] » sweetmarie, posted by dove on March 24, 2001, at 15:26:18
> >
> How long have you been trying medications? Has this combination improved your life significantly (i.e. are you able to function/see friends/go out etc? That`s all I`m asking of a medication really. The rest I can tackle myself (relationships, work, whatever).
> >
>
> I spent much of my childhood and teen-age years self-medicating, except for a stint on Tegretol (AED). I wasn't even prescribed the Tegretol for a mood-disorder but for my fainting/blackout episodes, labeling them seizures. I told doctors that I had depression, and they told me I needed more sunshine (which, looking back, was partially true), and I needed to eat better, needed to gain some weight (wish I had that problem still ;-) needed more vitamin C, more exercise, ect... I also had blinding migraines, still do; however, I now use preventative meds. And it was through my search for migraine relief (and making sure I wasn't having little strokes because I would "faint" or black-out before they came on) that I tried my first med that opened my eyes to an entirely new world that I had only dreamt of.
>
> I was prescribed Verapamil, a calcium-channel blocker used for heart-disease and treating migraines. It was like an OD on beautiful shiny reality, and I was flying. When they felt it was effecting the way my heart beats and causing me to gain weight they moved me to Amitriptyline. The Ami does quell my migraines but I fell into a deep depression after the Verapamil was removed. I kept telling my Internal Medicine Doc, and my other non-specialist doc's that I was depressed and had lost that feeling of being "normal". They all said it would take some time to feel the effects of Amitriptyline and that it was "after-all" an antidepressant!
>
> But I've never been that stable again, nor has the world been that beautiful, alive and real again. I finally received a referral and the permission to see a psych-doc, who dxed me with (in order of importance by his criteria): ADHD, OCD, GAD, Panic Disorder, PTSD, and Rapid Cycling Bi-polar, and I may have forgotten a few. Over time, with different doc's and different dxes, multiple therapists and multiple med trials, I've come to the point where the meds are kind of like a life-preserver in a raging sea, and I have to do some legwork myself to push that life-preserver back to safety. I also know that some meds try to drown me, while others keep me afloat; and that it's really hard to distinguish between the two when you're taking multiple meds.
>
> I have lost contact with all but my very best friend, who lives so far away that we rarely see each other but do talk on the phone every other month or so. I have been bound to the house for some time now, well over five years really. That is, until quite recently. A combination of events and med additions within the last 3-4 months have given me a little more strength, still not what my husband wants to see, but a major step for me.
>
> The primary med that started a slow change and some improvement is Neurontin, and then the addition of Klonopin, and then the addition of low-dose Prozac.
>
> The primary events are my Mom being dxed with Lymphoma and Thyroid cancer, missing my best friend's (who lives far away) marriage this past December and subsequently her Dad being dxed with Leukemia and throat cancer, my childhood and beloved Minister's sudden death at the age of 46, my Aunt's attempted suicide (resulting in hospitalization, ECT, and subsequent recovery); then my eldest son's Grandpa being dxed with cancer in the form of an inoperative and terminal brain tumor (who has a mere three weeks left even though there were no symptoms until last week.), and his Great Grandpa being dxed with Alzheimer's.
>
> So, I still don't want to go outside, or anywhere else, but I do feel more alive. I believe I'm still in the detached-unreality part of real comprehension of the losses. I cried and cried after learning of all and each illness and death, then I became settled enough to speak about these events without falling apart, but deep down there's a lot of fear. I've been writing at P-Babble for over three (1998?) years now, and my presence has been sporadic for the last year or so. I fear writing because all these things and more are wrapped around each other in my heart, soul and mind; and I can't seem to open up without everything surfacing and baring just a little too much flesh, and I then feel vulnerable and overwhelmed resulting in withdrawal once again.
>
> So, after my longgggg sob-story, I think there are meds that can help anyone and everyone at least a little, but it can be a tough journey finding them. Are you struggling with major (double?) depression and one of the anxiety/panic disorders (i.e. agoraphobia)? There are some extremely wise and intelligent, as well as beautiful and kind, people on this board; who share their med/chemical knowledge freely. Sometimes the meds that are "suppose to do the job" don't, and ones that aren't suppose to do the job do indeed do the job.
>
> I'd also be afraid of being in-patient, I was almost committed against my will in December 1999 and I totally freaked. However, if there really wasn't anything but darkness inside of me, and I was really near the end of no turning back, and I had a family whom I loved and who loved me; I would probably check myself in. Remember, there are different strategies and different "experts" all over the world, and though you may feel *this* expert is your last hope, it isn't! I promise you it isn't.
>
> My latest p-doc (also honored with the title "expert") has me taking Adderall, Serzone, Neurontin, Klonopin, Prozac, and Amitriptyline. The combo becomes a little complicated when trying to take 6-8 Neurontin Caplets, 4 Adderall tabs, 4 Serzone Tabs, 3 Klonopin miniature tabs, ect... but the combo is having some beneficial effect, a might bit slow, but better than no!
>
> Don't lose hope, that is probably one of the most important things you need to hold onto, even though it's probably the hardest; after-all, isn't depression all about losing hope. My prayers, thoughts, and hope are with you. I may not post all that often, but I still read, and my eyes and ears will be vigilantly with you on your journey.
>
> dove
Dear dove,Thank you for sharing all that - you have certainly `been through it` big-time. What are the chances of all those terrible things happening? You`ve certainly been very unlucky (and so have all the people you mention, of course). You`ve shown a lot of strength. I think that is where others (non sufferers) are wrong. I`m referring to those who believe that depression is a weakness, and something that results from too much self-indulgence. Why would we put ourselves through this hell?? We are very very strong people to be able to keep fighting. It`s easy to forget that. I woudn`t wish depression on anyone, but I would like the people who `dis` the illness as some kind of self pity to just spend a couple of days going through it. That would soon change their minds.
I`m sorry that you have lost friends because of you illness; I haven`t lost any of my important friends, although I haven`t seen them for ages (7 years in a couple of cases). The fact that they remain my friends is of constant astonishment to me, considering the input thay receive from me (practically none). I guess I`m lucky. I have, however, broken up with boyfriends as a direct result of my illness, which is hard to take. I know now that I can`t even entertain the idea of another one until such a time as I am well enough to. Like you, I very rarely leave my flat (and haven`t done for the past 3 years more or less). Just feel too ill, and the constant pretence to others that I`m O.K. is a nightmare which leaves me absolutely exhausted.
You have been diagnosed with a lot of things. Which one? Or don`t they know exactly? Or do you actually have all these conditions? I guess I`m `lucky` that I only suffer from severe depression. I imagine that is easier to treat (albeit very difficult in my case). When I say `lucky`, I mean the complete opposite in terms of suffering, but you see what I mean (I hope!).
I don`t know where you live, but in the UK there are only 2 clinics that deal in `treatment resistant depression`. The one I`m going to has been referred to as a `centre of excellence`, and the Pressor is known to be one of the best in this field. I have to wait and see, I guess. I suppose that he has up to the minute info on anti-depressant medications, and even when I leave the hospital he will be advising my regular psychiatrist (that is unless he gets it right whilst I`m an in-patient. I`m hoping he does).
Thanks again for your support and prayers, they are very much appreciated.
Love,
Anna.
Posted by sweetmarie on March 25, 2001, at 6:33:41
In reply to Re: treatment resistant depre, [LONG] » sweetmarie, posted by dove on March 24, 2001, at 15:26:18
> >
> How long have you been trying medications? Has this combination improved your life significantly (i.e. are you able to function/see friends/go out etc? That`s all I`m asking of a medication really. The rest I can tackle myself (relationships, work, whatever).
> >
>
> I spent much of my childhood and teen-age years self-medicating, except for a stint on Tegretol (AED). I wasn't even prescribed the Tegretol for a mood-disorder but for my fainting/blackout episodes, labeling them seizures. I told doctors that I had depression, and they told me I needed more sunshine (which, looking back, was partially true), and I needed to eat better, needed to gain some weight (wish I had that problem still ;-) needed more vitamin C, more exercise, ect... I also had blinding migraines, still do; however, I now use preventative meds. And it was through my search for migraine relief (and making sure I wasn't having little strokes because I would "faint" or black-out before they came on) that I tried my first med that opened my eyes to an entirely new world that I had only dreamt of.
>
> I was prescribed Verapamil, a calcium-channel blocker used for heart-disease and treating migraines. It was like an OD on beautiful shiny reality, and I was flying. When they felt it was effecting the way my heart beats and causing me to gain weight they moved me to Amitriptyline. The Ami does quell my migraines but I fell into a deep depression after the Verapamil was removed. I kept telling my Internal Medicine Doc, and my other non-specialist doc's that I was depressed and had lost that feeling of being "normal". They all said it would take some time to feel the effects of Amitriptyline and that it was "after-all" an antidepressant!
>
> But I've never been that stable again, nor has the world been that beautiful, alive and real again. I finally received a referral and the permission to see a psych-doc, who dxed me with (in order of importance by his criteria): ADHD, OCD, GAD, Panic Disorder, PTSD, and Rapid Cycling Bi-polar, and I may have forgotten a few. Over time, with different doc's and different dxes, multiple therapists and multiple med trials, I've come to the point where the meds are kind of like a life-preserver in a raging sea, and I have to do some legwork myself to push that life-preserver back to safety. I also know that some meds try to drown me, while others keep me afloat; and that it's really hard to distinguish between the two when you're taking multiple meds.
>
> I have lost contact with all but my very best friend, who lives so far away that we rarely see each other but do talk on the phone every other month or so. I have been bound to the house for some time now, well over five years really. That is, until quite recently. A combination of events and med additions within the last 3-4 months have given me a little more strength, still not what my husband wants to see, but a major step for me.
>
> The primary med that started a slow change and some improvement is Neurontin, and then the addition of Klonopin, and then the addition of low-dose Prozac.
>
> The primary events are my Mom being dxed with Lymphoma and Thyroid cancer, missing my best friend's (who lives far away) marriage this past December and subsequently her Dad being dxed with Leukemia and throat cancer, my childhood and beloved Minister's sudden death at the age of 46, my Aunt's attempted suicide (resulting in hospitalization, ECT, and subsequent recovery); then my eldest son's Grandpa being dxed with cancer in the form of an inoperative and terminal brain tumor (who has a mere three weeks left even though there were no symptoms until last week.), and his Great Grandpa being dxed with Alzheimer's.
>
> So, I still don't want to go outside, or anywhere else, but I do feel more alive. I believe I'm still in the detached-unreality part of real comprehension of the losses. I cried and cried after learning of all and each illness and death, then I became settled enough to speak about these events without falling apart, but deep down there's a lot of fear. I've been writing at P-Babble for over three (1998?) years now, and my presence has been sporadic for the last year or so. I fear writing because all these things and more are wrapped around each other in my heart, soul and mind; and I can't seem to open up without everything surfacing and baring just a little too much flesh, and I then feel vulnerable and overwhelmed resulting in withdrawal once again.
>
> So, after my longgggg sob-story, I think there are meds that can help anyone and everyone at least a little, but it can be a tough journey finding them. Are you struggling with major (double?) depression and one of the anxiety/panic disorders (i.e. agoraphobia)? There are some extremely wise and intelligent, as well as beautiful and kind, people on this board; who share their med/chemical knowledge freely. Sometimes the meds that are "suppose to do the job" don't, and ones that aren't suppose to do the job do indeed do the job.
>
> I'd also be afraid of being in-patient, I was almost committed against my will in December 1999 and I totally freaked. However, if there really wasn't anything but darkness inside of me, and I was really near the end of no turning back, and I had a family whom I loved and who loved me; I would probably check myself in. Remember, there are different strategies and different "experts" all over the world, and though you may feel *this* expert is your last hope, it isn't! I promise you it isn't.
>
> My latest p-doc (also honored with the title "expert") has me taking Adderall, Serzone, Neurontin, Klonopin, Prozac, and Amitriptyline. The combo becomes a little complicated when trying to take 6-8 Neurontin Caplets, 4 Adderall tabs, 4 Serzone Tabs, 3 Klonopin miniature tabs, ect... but the combo is having some beneficial effect, a might bit slow, but better than no!
>
> Don't lose hope, that is probably one of the most important things you need to hold onto, even though it's probably the hardest; after-all, isn't depression all about losing hope. My prayers, thoughts, and hope are with you. I may not post all that often, but I still read, and my eyes and ears will be vigilantly with you on your journey.
>
> dovedove,
P.S. to my previous posting.
You say that you responded well to one med combo; as I`m sure I mentioned, I responded very well with Dothiepin (and saw the world in a way I`d never seen it before, it was incredible). Surely, having responded to a medication (or medications), then it shows that this is possible and the odds are in our favour in finding another. This may be convaluted logic, but it seems kind of reasonable to me.
Anna.
Posted by Censerd on March 26, 2001, at 12:35:47
In reply to Re: treatment resistant depre, [LONG] » dove, posted by sweetmarie on March 25, 2001, at 6:33:41
> Hi all, I've never posted here before but always stop by to read and this is a topic I can totally relate to! I am 31 and have been being treated for depression off and on since I was 13. Meds were started at 17 and didn't go well, tried them again at 22 with no success - just lots of bad side effects! After my daughter was born in 1993, I gained a lot of weight (I'd always been heavy but gained even more) I had weight loss surgery and lost over 100 lbs. I thought this would give me the energy and motivation I needed to get off the couch and be able to play with my daughter - it didn't help any, I was/am skinny but still had no energy and a bad temper to boot! So I tried to get help again from my regular doc - she said she thought I had a-typical depression. Medication merry go round started again and I ended up on Celexa for about 1 year as it had the least side effects of any but they were too much to stay on any longer (mostly intenstinal stuff). She said to try Lithobid (lithium) as maybe I had bi-polar II since I wasn't responding to any AD's like I should. So now I had to go to a psychiatrist for med management. He didn't do much for me except write out prescriptions. My insurance changed so I had to change doc's again. First visit she said she wondered if I had ADD. I said no way, not me! Next visit she said what about ADD? and told me to research and read a book or 2 and let her know what I thought. Well, I borrowed a book from a friend and after reading just the introduction in "Driven to Distraction" my jaw hit the floor!!! This was me to a T! Well, to try and make a long post a little shorter, after tests and appointment I was diagnosed with ADD 3 weeks ago. I now take a combo of Ritalin and Concerta and I feel like crying because for the first time in my life that I can remember - I am sleeping well at night and - here's the big one - I actually feel awake during the day! I am capable of getting things done! I'm not a dynamo yet because I have to figure out how to do the stuff I haven't been doing for years but now I know I can get there!
The point of this gawd awful long post is to offer everyone on the med merry go round some hope and encouragement. I thought I had no more hope of every feeling "normal" or having energy, it just took perserverence and a lot more tries but so far - it's definately been worth it.
So to everyone who made it through this post - thanks for reading and keep perservering - there is a med, support group, or something for all of us.
Chris
Posted by sweetmarie on March 27, 2001, at 14:24:57
In reply to Re: treatment resistant depression-Lamictal » sweetmarie, posted by JahL on March 23, 2001, at 11:47:53
> > > > I've had high-dose trials of all the meds you mention, & many more besides. All w/out significant success...that was until I started Lamotrigine just over 2 wks ago. I'm only just up to 37.5mg but already the improvement has been dramatic (see 'BIPOLAR EXPERT' thread 4 details).
>
> > > >At yr current 25mg dose I can almost *guarantee* (tho' definitely no expert) you won't feel significant remission of yr depression. The proposed 250mg will give Lamotrigine scope to work it's magic (I'm biased).
>
> > > >You are fortunate to have found such a forward-thinking UK pdoc-I can't even find one to prescribe Lamotr. monotherapy, let alone such 'power combos'. I have to order mine from abroad (tut,tut,eh steve?). It's just a shame you have to reside in hospital.
>
> > > >I have high hopes for the Lamotrigine (which has the most anti-depressive profile of the mood-stabilizers); you may even find the Venlafaxine+Mirtazapine become/are redundant!
>
>
> > I`m sorry to bug you. You mentioned Lactimal working it`s `magic` - does this mean that it has had an effect, or just that you are expecting it to?
>
> HI Anna.
>
> The 'magic' I speak of refers to sporadic rpts I have read of Lamotrigine vanquishing resistant depression where all else had failed. Of course these give no guarantee.
>
> I'm only on 67.5mg but already there are robust improvements in cognition, co-ordination & social phobia. No great improvement in mood but that generally requires higher doses (which I'm building up to).
>
> > I am now on 200 mg (since March 18th - 6 days now), and so far I don`t feel a thing. Do you reckon it`s too early to know? The intended dose that I`m aiming for is 250 mg, but I`m leaving that until I go into Hospital in 3 weeks or so. Am I being impatient? (I expect I am, only I`m just so ill).
>
> If you're impatient then so am I; this cautious upwards titration goes against my nature.
>
> 250 sounds like a good dose if it's the only anti-convulsant you're taking. I have read that for some a *month+* @ therapeutic doses is required for a response. I think there's a lot of guesswork involved since Lamotrigine's use in mood disorders is a fairly recent development.
>
> > Again, sorry to hassle you (you don`t have to answer this if you don`t want to).
>
> No worries!
>
> J.Jah,
I spoke to the `medication helpline` (a helpline that specifically deals with psychiatric medications, based in the Affective Disorders Unit at the Maudsley Hospital in London) regarding Lamotragine. The woman I spoke to told me that there wasn`t too much info about the drug as it`s so new (as we know). However, she was able to look into a file they have about it. She quoted a case study of a woman who had been on Lamotragine for 7 weeks, felt completely well and went back to work (a concept that I can`t even think about - I haven`t worked for 3 years now). Also, she found a research project, which quoted `4 +` weeks for any effect. This was helpful as far as it went, but like I said, info about Lamotragine is pretty thin on the ground as yet.
I have a question that I meant t ask her, and was wondering if you knew the answer. Do I count ALL the weeks that I have been on an increased dose, or the weeks that I have been on the top dose, or rather the optimum dose for me (250 mg)? Do you know? I`ve always been a bit hazy on this whole time-scale business.
Cheers,
Anna.
Posted by Christina on March 27, 2001, at 15:34:29
In reply to Re: treatment resistant depre, [LONG] » dove, posted by sweetmarie on March 25, 2001, at 6:33:41
> P.S. to my previous posting.
>
> You say that you responded well to one med combo; as I`m sure I mentioned, I responded very well with Dothiepin (and saw the world in a way I`d never seen it before, it was incredible). Surely, having responded to a medication (or medications), then it shows that this is possible and the odds are in our favour in finding another. This may be convaluted logic, but it seems kind of reasonable to me.
>
> Anna.Anna:
What sort of drug is Dothiepin? Is that the Brand name? Is is something only available in the UK?You mentioned that it helped you. Are you still on it?
I'm very curious. I've been on all sorts of med cocktails for depression, and I haven't had much luck.
Posted by JahL on March 27, 2001, at 16:36:19
In reply to Re: treatment resistant depression-Lamictal » JahL, posted by sweetmarie on March 27, 2001, at 14:24:57
> > I spoke to the `medication helpline` (a helpline that specifically deals with psychiatric medications, based in the Affective Disorders Unit at the Maudsley Hospital in London) regarding Lamotragine. The woman I spoke to told me that there wasn`t too much info about the drug as it`s so new (as we know). However, she was able to look into a file they have about it. She quoted a case study of a woman who had been on Lamotragine for 7 weeks, felt completely well and went back to workThe 'magic'?!
> >(a concept that I can`t even think about - I haven`t worked for 3 years now). Also, she found a research project, which quoted `4 +` weeks for any effect. This was helpful as far as it went, but like I said, info about Lamotragine is pretty thin on the ground as yet.
> > I have a question that I meant t ask her, and was wondering if you knew the answer. Do I count ALL the weeks that I have been on an increased dose, or the weeks that I have been on the top dose, or rather the optimum dose for me (250 mg)? Do you know? I`ve always been a bit hazy on this whole time-scale business.Hi Anna.
I'm pretty sure it's 4wks (not set in stone of course) *from* when you reach a therapeutic dose (ie one that will provoke a response in you) So if 250mg is going to work then it might take 4 wks @ this dose before you begin improving.
I guess the secret is to continue gradually increasing the dose (thus testing a good dose range) until you get a result. Then you can gradually titrate downwards until yr response begins to remit. Just above this point is yr optimal dose.
J.
Posted by sweetmarie on March 28, 2001, at 3:43:01
In reply to Re: treatment resistant depression » sweetmarie, posted by Christina on March 27, 2001, at 15:34:29
>
> > P.S. to my previous posting.
> >
> > You say that you responded well to one med combo; as I`m sure I mentioned, I responded very well with Dothiepin (and saw the world in a way I`d never seen it before, it was incredible). Surely, having responded to a medication (or medications), then it shows that this is possible and the odds are in our favour in finding another. This may be convaluted logic, but it seems kind of reasonable to me.
> >
> > Anna.
>
> Anna:
> What sort of drug is Dothiepin? Is that the Brand name? Is is something only available in the UK?
>
> You mentioned that it helped you. Are you still on it?
>
> I'm very curious. I've been on all sorts of med cocktails for depression, and I haven't had much luck.Christina,
Dothiepin is a tricyclic anti-depressant. It is available in the States, under the brand name Prothiedin (I think I`m right in saying). I can`t remember the generic (if that`s the correct word) name for it, but it can be easily found on one of the medication web-sites.
It was the first anti-depressant I was prescribed, and it worked for me 100%. It worked so well that, in conjunction with my GP, I came off it after a year. The depression came back almost immediately (worse than before in fact), so I went back onto it. Unfortunately, it failed to have any effect at all 2nd time around, although I persisted with it (at all levels of dosage) for a further 18 months. Since then, nothing has worked (I won`t bore you with details, but I`ve recently done a tally of all the meds I`ve been on since then and come up with the total of 12 - not including all the different permutations of those. Also ECT didn`t work). So, no I`m not still on it, but curse my folly in discontinuing it all the time. I thought I was a bit freakish that it didn`t work 2nd time (what was wrong with me? etc), but I`ve since found out that this is not uncommon at all.
Anyway, I wish you luck if you decide to give it a try.
Anna.
Posted by sweetmarie on March 28, 2001, at 3:54:12
In reply to Re: treatment resistant depression-Lamictal » sweetmarie, posted by JahL on March 27, 2001, at 16:36:19
>
> > > I spoke to the `medication helpline` (a helpline that specifically deals with psychiatric medications, based in the Affective Disorders Unit at the Maudsley Hospital in London) regarding Lamotragine. The woman I spoke to told me that there wasn`t too much info about the drug as it`s so new (as we know). However, she was able to look into a file they have about it. She quoted a case study of a woman who had been on Lamotragine for 7 weeks, felt completely well and went back to work
>
> The 'magic'?!
>
> > >(a concept that I can`t even think about - I haven`t worked for 3 years now). Also, she found a research project, which quoted `4 +` weeks for any effect. This was helpful as far as it went, but like I said, info about Lamotragine is pretty thin on the ground as yet.
>
> > > I have a question that I meant t ask her, and was wondering if you knew the answer. Do I count ALL the weeks that I have been on an increased dose, or the weeks that I have been on the top dose, or rather the optimum dose for me (250 mg)? Do you know? I`ve always been a bit hazy on this whole time-scale business.
>
> Hi Anna.
>
> I'm pretty sure it's 4wks (not set in stone of course) *from* when you reach a therapeutic dose (ie one that will provoke a response in you) So if 250mg is going to work then it might take 4 wks @ this dose before you begin improving.
>
> I guess the secret is to continue gradually increasing the dose (thus testing a good dose range) until you get a result. Then you can gradually titrate downwards until yr response begins to remit. Just above this point is yr optimal dose.
>
> J.Jah,
Thanks. As you know, I haven`t increased the dosage slowly at all (25 mg - 250 mg in about 4 weeks). I think, however that this is because of the fact that I`am simultaneously coming off my other meds, and tend to become very ill indeed when I do this - iller than I am at the moment, which is pretty ******* ill (nearly catatonic, as I`m sure I`ve mentioned before). This is my theory anyway, and it was made as a result of past experience by my consultant (of my reaction to med changes).
I`m actually hoping that the Lactimal will `do the job` on it`s own - hence the question. In other words, I`m hoping that the Venlafaxine and Mirtazapine will not be necessary. This is my hope anyway, but if it doesn`t happen, so be it (at the end of the day, I don`t actually give a monkeys haow many drugs I take, so long as they are successful. And don`t make me look like the Michelin man, which is what Nardil has done).
Cheers,
Anna.
Posted by SLS on March 28, 2001, at 8:48:10
In reply to Re: treatment resistant depression » Christina, posted by sweetmarie on March 28, 2001, at 3:43:01
Hi Anna.
> It [dothiepin] was the first anti-depressant I was prescribed, and it worked for me 100%. It worked so well that, in conjunction with my GP, I came off it after a year. The depression came back almost immediately (worse than before in fact), so I went back onto it. Unfortunately, it failed to have any effect at all 2nd time around, although I persisted with it (at all levels of dosage) for a further 18 months.
> So, no I`m not still on it, but curse my folly in discontinuing it all the time
I know you realize that you made a perfectly logical decision with the information you were provided; a decision driven by a very understandable desire to discontinue a drug, along with its side effects, that is no longer needed. It is also understandable that you should not want to "rely" on any drug to remain healthy. People with all sorts of illnesses want to be able to live without the drugs they are taking. Many of them petition their doctors to discontinue their medication. It is the responsibility of the doctor to council the patient as to whether or not they should and, ideally, to explain to the patient why. It seems that your doctor at the time did not possess the information regarding antidepressant continuation. At that time, perhaps psychiatry had not yet recognize the potential for post-discontinuation treatment-resistance. Perhaps it was, but your G.P. was without the expertise to remain current with psychiatric issues. Either way, your decision at that time made sense.
"What if...?"
20/20 hindsight provides an unfair advantage for those who have it in advance. I can look back 13 years ago and isolate a single decision made by my doctor that resulted in the loss of my late 20's, all of my 30's, and still counting. I can look back on some of my own treatment decisions that, in retrospect, could have prevented me from getting well. Still, I remember how human I was at the time I made these decisions, and try not to place too much weight upon my shoulders for the blame and guilt I feel for having made them.
I know 12 drugs sounds like a big number. It is. However, compared to some of the people here, you have plenty more treatment possibilities ahead of you than you have had behind you. You should remain optimistic.
I do not regard your decision to discontinue dothiepin as "folly", whether you were counciled properly or not. I wish that I had followed some of my doctors' advise instead of f____ing (follying) around. I try to learn from my past so that I can provide myself with a better chance of having a future.
Sincerely,
Scott
Posted by sweetmarie on March 28, 2001, at 11:35:39
In reply to Re: treatment resistant depression » sweetmarie, posted by SLS on March 28, 2001, at 8:48:10
> Hi Anna.
>
> > It [dothiepin] was the first anti-depressant I was prescribed, and it worked for me 100%. It worked so well that, in conjunction with my GP, I came off it after a year. The depression came back almost immediately (worse than before in fact), so I went back onto it. Unfortunately, it failed to have any effect at all 2nd time around, although I persisted with it (at all levels of dosage) for a further 18 months.
>
> > So, no I`m not still on it, but curse my folly in discontinuing it all the time
>
> I know you realize that you made a perfectly logical decision with the information you were provided; a decision driven by a very understandable desire to discontinue a drug, along with its side effects, that is no longer needed. It is also understandable that you should not want to "rely" on any drug to remain healthy. People with all sorts of illnesses want to be able to live without the drugs they are taking. Many of them petition their doctors to discontinue their medication. It is the responsibility of the doctor to council the patient as to whether or not they should and, ideally, to explain to the patient why. It seems that your doctor at the time did not possess the information regarding antidepressant continuation. At that time, perhaps psychiatry had not yet recognize the potential for post-discontinuation treatment-resistance. Perhaps it was, but your G.P. was without the expertise to remain current with psychiatric issues. Either way, your decision at that time made sense.>
> "What if...?"
>
> 20/20 hindsight provides an unfair advantage for those who have it in advance. I can look back 13 years ago and isolate a single decision made by my doctor that resulted in the loss of my late 20's, all of my 30's, and still counting. I can look back on some of my own treatment decisions that, in retrospect, could have prevented me from getting well. Still, I remember how human I was at the time I made these decisions, and try not to place too much weight upon my shoulders for the blame and guilt I feel for having made them.> > I know 12 drugs sounds like a big number. It is. However, compared to some of the people here, you have plenty more treatment possibilities ahead of you than you have had behind you. You should remain optimistic.
>
> I do not regard your decision to discontinue dothiepin as "folly", whether you were counciled properly or not. I wish that I had followed some of my doctors' advise instead of f____ing (follying) around. I try to learn from my past so that I can provide myself with a better chance of having a future.
>
>
> Sincerely,
> ScottDear Scott,
I appreciate your reponse to my post. You`re absolutely right of course: how could my GP have known that I would subsequently be treatment resistant - after all, it was the very 1st medication I had ever taken for depression. As you also point out, it`s doubtful that a GP would be up to scratch with psychiatric medications (after all, a good many psychiatric doctors aren`t either). There really isn`t much point in looking back and wishing it could have been different - as my mother says, it`s where I am now and the future that counts. As you know, mothers have an inherent knack of being `right` (hmmmm...) I do feel though, that it probably bodes well in the sense that I have responded in the past, so it can`t be completely outside of my capabilities (convaluted logic? - maybe).
I`m interested to know what you meant by a decision made 13 years ago, which screwed up your late 20s etc. What was that (don`t tell me if you don`t want to - I`m just curious). Up until 3 years ago, I hadn`t actually been treated by a psych doctor at all - I had always been treated by my GP (first of all in Cambridge where I used to live, and then by my GP here in Leeds). It wasn`t until 3 years ago (almost to the day) that my GP realized that I needed `proper` help. Although I know that this is a waste of time, I do find myself asking the question how come it took them so long to refer me on to a psychiatric proffessional. After all, I had been on quite a few different med with them (Dothiepin, Seroxat, Prozac, Favorin, Lustral, Reboxetine and Venlafaxine - all these spanning 7 years with no results at all). As it turned out, the psychiatrist I was referred to was a complete w****r (I feel very strongly about this man - he`s totally incompetent to say the least, and whilst I was `under` him - 18 months - he put me on Imipramine, and when that failed to work, he tried ECT and when that failed, he told me that there was nothing further he could do for me). Two other of my friends have left him (as I did), and one of them made a formal complaint against him. He`s still practising though. I don`t know quite why I`m telling you all this, except for the fact that I feel, as you obviously do, that much time has been wasted. It astonishes me that I wasn`t actually diagnosed treatment resistant until I came under the care of my current psychiatrist. The facts were all there ... Still, I guess now that it has been recognised, it can be properly treated. Also, having seen the specialist, the diagnosis is even more accurate, which I`m hoping will narrow the field even further. Hindsight is all very well, but it really ought to be something we learn from, rather than something we beat ourselves up over (which I do on a regular basis).
Anyway, I won`t go on any more. How is the Lamotragine situation (I could have got this wrong, but didn`t you say that you had started taking it)?
Cheers,
Anna.
Posted by sweetmarie on March 31, 2001, at 6:53:13
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on March 10, 2001, at 6:22:05
> > Okay, sweetmarie, I did not want to alarm you but I thought you were in a hospital setting. Please read the following quote from Dr. Ivan Goldberg's depression central ( http://www.psycom.net/depression.central.lamotrigine.html ):
> >
> > "14. Which side-effects are severe enough to force people to discontinue lamotrigine?
> >
> > The side-effect of lamotrigine that most often causes the drug to be discontinued is a rash. Rashes can be mild, similar to a slight sunburn, or can be quite severe resembling a severe case of poison-ivy. The more severe the rash the less likely it is that the individual will be able to continue the medication. ALL rashes should be reported to the physicians prescribing the lamotrigine.
> >
> > A rash is more likely to develop when the initial doses of lamotrigine are high or when lamotrigine is too rapidly started when someone is taking valproate.
> >
> > It is important that people taking lamotrigine who develop a rash immediately contact their physician as there have been a few deaths in people who have developed lamotrigine-induced rashes."
> >
> > I think the name of the deadly rash problem is Steven-Johnson's Syndrome. It does not seem that your prescribing doc is aware of this? How much of an increase in dosage has he/she prescribed for you?
> >
> > Again, best wishes.
>
> The rash is similar to a `dry skin rash`, of the kind I have always had on my upper arms, except now it`s got worse and is more noticeable. It`s interesting that you make the Vaproate connection, as I am also taking this. However, I am coming off this - slowly decreasing the dosage until I come off altogether. Possibly this will help. I will certainly point the rash out to the psych doctors when I go into hospital (if it`s still there).
>
> sweetmariePhillybob,
Re. my rash. It`s not (as you quoted) anything like sunburn or poison ivy reaction. I have since found out that it is `folliculitis`, which is an infection of the hair follicles - each follicle develops a tiny spot type thing. I`ve always had this on my legs, but only very mildly. I`m wondering therefore, whether it IS anything to do with the Lamictal; maybe it`s the result of one of the other drugs, or even the result of the combination. It could have absoutely nothing to do with my meds, although it`s a bit wierd that it`s developed since going onto this combination. I`m almost 100% sure that it is not dangerous, but I still really hate it (although I suppose that this ought to be secondary to my health, but nonetheless ...)
Have you heard of this condition? Has anyone? Any clue as to whether it could be medication related? Maybe someone else has developed the same thing?
Any ideas appreciated.
Anna.
Posted by phillybob on April 1, 2001, at 22:52:52
In reply to Re: treatment resistant depression » sweetmarie, posted by sweetmarie on March 31, 2001, at 6:53:13
> > Have you heard of this condition? Has anyone? Any clue as to whether it could be medication related? Maybe someone else has developed the same thing?
Hi, Anna. Just back from a weekend trip (or holiday as the Brits might say?). Anyway, I myself have not heard of what you are talking about but have always imagined (I'd hypothesize, but I'm not sure if I believe my imagination that strongly) that when one puts something foreign into the body (i.e. medication) that the body can and might act funky ... thus, your exacerbation of an existing problem?Anyhow, I'm glad that you have found out what the rash is. With that information, you should be able to rest much better. Now, just to get up to a therapeutic dose for an appropriate amount of time and hoping it works, eh?
I myself am still only at 50 mg/day of Lamictal ... taking it very slowly. However, to help pass the time (as I build up), I've added 5mg 2 times/day of Adderal (which works well for my younger brother) and since I seemed to have some positive effects in the past with Ritalin which then petered out, I thought it was worth a shot ... so far (3 days), I'm better than I was and think my patience in building up the Lamictal will hold out.
Hope you are doing well!
[P.S. Just got a DVD player and am in the midst of watching Dylan's last accoustic shows in England in '65 (?) in the documentary "Don't Look Back." The intro with Subterranean Homesick Blues is worth the bucks so far! Also, got "Man in the Sand" which is a documentary on the making of the Mermaid Avenue albums which are Woody Guthrie songs sung by Billy Bragg and my fave, Wilco]
Posted by sweetmarie on April 2, 2001, at 6:26:31
In reply to Re: treatment resistant depression , posted by phillybob on April 1, 2001, at 22:52:52
> > > Have you heard of this condition? Has anyone? Any clue as to whether it could be medication related? Maybe someone else has developed the same thing?
>
>
> Hi, Anna. Just back from a weekend trip (or holiday as the Brits might say?). Anyway, I myself have not heard of what you are talking about but have always imagined (I'd hypothesize, but I'm not sure if I believe my imagination that strongly) that when one puts something foreign into the body (i.e. medication) that the body can and might act funky ... thus, your exacerbation of an existing problem?
>
> Anyhow, I'm glad that you have found out what the rash is. With that information, you should be able to rest much better. Now, just to get up to a therapeutic dose for an appropriate amount of time and hoping it works, eh?
>
> I myself am still only at 50 mg/day of Lamictal ... taking it very slowly. However, to help pass the time (as I build up), I've added 5mg 2 times/day of Adderal (which works well for my younger brother) and since I seemed to have some positive effects in the past with Ritalin which then petered out, I thought it was worth a shot ... so far (3 days), I'm better than I was and think my patience in building up the Lamictal will hold out.
>
> Hope you are doing well!
>
> [P.S. Just got a DVD player and am in the midst of watching Dylan's last accoustic shows in England in '65 (?) in the documentary "Don't Look Back." The intro with Subterranean Homesick Blues is worth the bucks so far! Also, got "Man in the Sand" which is a documentary on the making of the Mermaid Avenue albums which are Woody Guthrie songs sung by Billy Bragg and my fave, Wilco]Phillybob
Thanks for your reply. I guess you could be right about the rash/whatever the hell it is. When I first went to my GP about it, she asked whether I`d just begun any different drug treatment, and I said I hadn`t. I actually don`t think I had - in fact, I think that this was PRE Lamictal. I dunno, my mind plays tricks on me since I`ve been feeling this ill (3 whole years now - I don`t know how I`ve coped! I have though). The most recent theory I`ve come up with is that the skin condidion has something to do with mood/body metabolism or something. The reason for this line of thought, is that when I was first very ill - 6 years ago (the first time that I have had to take time off work with it), I developed acne on the lower half of my face, and all over my chest (pleasant!). This cleared up when I started feeling (a tad) better. It`s all very confusing, but I`m telling myself to put it on the `back burner` until such a time as I am better (if of course this ever happens). I just really bloody hate it ... Still. That`s life.
[I have `Don`t Look Back` on video (it is his 1965 tour of England). Definitely worth watching - just don`t watch it too much. Did you spot Allen Ginsberg in the background of the `Subterranean Homesick Bluse` bit at the beginning? I don`t know quite why he was there ...]
Anna.
P.S. I`ve been on the `terapeutic dose` of Lamictal (250 mg) for a week and a half, and absolutely no change. Still early days I guess, and it was never intended as a medication on it`s own - i.e. it is meant as a part of a combination (Mirtazapine/Venlafaxine/Lamotragine). I was just hoping that the others would be unnecessary.
Posted by sweetmarie on April 2, 2001, at 6:31:24
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on April 2, 2001, at 6:26:31
> > > > Have you heard of this condition? Has anyone? Any clue as to whether it could be medication related? Maybe someone else has developed the same thing?
> >
> >
> > Hi, Anna. Just back from a weekend trip (or holiday as the Brits might say?). Anyway, I myself have not heard of what you are talking about but have always imagined (I'd hypothesize, but I'm not sure if I believe my imagination that strongly) that when one puts something foreign into the body (i.e. medication) that the body can and might act funky ... thus, your exacerbation of an existing problem?
> >
> > Anyhow, I'm glad that you have found out what the rash is. With that information, you should be able to rest much better. Now, just to get up to a therapeutic dose for an appropriate amount of time and hoping it works, eh?
> >
> > I myself am still only at 50 mg/day of Lamictal ... taking it very slowly. However, to help pass the time (as I build up), I've added 5mg 2 times/day of Adderal (which works well for my younger brother) and since I seemed to have some positive effects in the past with Ritalin which then petered out, I thought it was worth a shot ... so far (3 days), I'm better than I was and think my patience in building up the Lamictal will hold out.
> >
> > Hope you are doing well!
> >
> > [P.S. Just got a DVD player and am in the midst of watching Dylan's last accoustic shows in England in '65 (?) in the documentary "Don't Look Back." The intro with Subterranean Homesick Blues is worth the bucks so far! Also, got "Man in the Sand" which is a documentary on the making of the Mermaid Avenue albums which are Woody Guthrie songs sung by Billy Bragg and my fave, Wilco]
>
> Phillybob
>
> Thanks for your reply. I guess you could be right about the rash/whatever the hell it is. When I first went to my GP about it, she asked whether I`d just begun any different drug treatment, and I said I hadn`t. I actually don`t think I had - in fact, I think that this was PRE Lamictal. I dunno, my mind plays tricks on me since I`ve been feeling this ill (3 whole years now - I don`t know how I`ve coped! I have though). The most recent theory I`ve come up with is that the skin condidion has something to do with mood/body metabolism or something. The reason for this line of thought, is that when I was first very ill - 6 years ago (the first time that I have had to take time off work with it), I developed acne on the lower half of my face, and all over my chest (pleasant!). This cleared up when I started feeling (a tad) better. It`s all very confusing, but I`m telling myself to put it on the `back burner` until such a time as I am better (if of course this ever happens). I just really bloody hate it ... Still. That`s life.
>
> [I have `Don`t Look Back` on video (it is his 1965 tour of England). Definitely worth watching - just don`t watch it too much. Did you spot Allen Ginsberg in the background of the `Subterranean Homesick Bluse` bit at the beginning? I don`t know quite why he was there ...]
>
> Anna.
>
> P.S. I`ve been on the `terapeutic dose` of Lamictal (250 mg) for a week and a half, and absolutely no change. Still early days I guess, and it was never intended as a medication on it`s own - i.e. it is meant as a part of a combination (Mirtazapine/Venlafaxine/Lamotragine). I was just hoping that the others would be unnecessary.p.p.s.
That should be `Subterrenean Homesick Blues` and `therapeutic`, although you probably didn`t need telling (don`t like making `typos` - bit anal retentive when it comes to spelling)
Anna.
Posted by SLS on April 2, 2001, at 9:50:36
In reply to Re: treatment resistant depression , posted by phillybob on April 1, 2001, at 22:52:52
Hi PhillyBob.
> I myself am still only at 50 mg/day of Lamictal ... taking it very slowly. However, to help pass the time (as I build up), I've added 5mg 2 times/day of Adderal (which works well for my younger brother) and since I seemed to have some positive effects in the past with Ritalin which then petered out, I thought it was worth a shot ... so far (3 days), I'm better than I was and think my patience in building up the Lamictal will hold out.
It sounds like a good plan to me. I hope the Adderall continues to give you what you want. I am curious if your doctor prescribed it and who's idea it was.
By the way, I need to take 300mg of Lamictal to receive any benefit from it.
Thanks.
- Scott
Posted by phillybob on April 2, 2001, at 12:43:33
In reply to Re: treatment resistant depression , posted by SLS on April 2, 2001, at 9:50:36
> I am curious if your doctor prescribed it [the Adderall] and who's idea it was.
>
> By the way, I need to take 300mg of Lamictal to receive any benefit from it.
>
> Thanks.
>
>
> - ScottHi, Scott. The Adderall was my idea after some thinkin' about my past brief experiences with Ritalin and recently talkin' with the younger bro about his experiences. I definitely have always had ADD problems but never got past a Ritalin trial, for some reason. I remember reading John L's concise analysis and discussion of "line of fire" approaches to depression treatment, including benign and fast-acting stimulants ( http://www.dr-bob.org/babble/20000209/msgs/20873.html ). Anyway, the pdoc and I discussed Adderall and Dexadrine and felt, based upon my bro's success, Adderall would be worth a trial right now.
Nonetheless, based upon my brief (almost 2 months) but "total" "cure" for my symptoms (atypical-type AD-treatment-resistent depression ... an oxymoron?) with Topamax, I think this class of "neuromodulatory" drugs would have good long-term efficacy for me. [From the Topamax Experiences thread ( http://www.dr-bob.org/babble/20001231/msgs/50878.html ), I discontinued Topamax due to a bad side effect of receding gums; however, I would certainly re-visit it at a lower dose in the future as an adjunct for a partial or in lieu of a failed Lamictal response.]
My pdoc is very receptive to what I have to say due to my fondness for research and his own broad experience with most all meds. Bottomline, if it makes sense, he's game. He was, however, a bit more squeamish about the Lamictal trial due to his concerns about the rash (Steven-Johnson's). Ultimately, he's been quite fine as a professional in keeping my impatience in cheque (i.e. taking the titration slowly).
(I actually had, years ago, fairly exhausted the bulk of my psychotherapy needs with another counselor who happened to be my pdoc's daughter! Of course, there is still on-going ancillary psychotherapy-type discussions with my pdoc as I fine tune my understanding of my life and reactions to life.)
What kind of benefit do you think you receive from Lamictal? (Also, I forgot, what other meds are you taking and at what dosages?)
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