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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on April 22, 2006, at 21:07:20
In reply to Re: bupe is still out there, right? » pseudoname, posted by SLS on April 22, 2006, at 14:52:24
Scott I know I'm changing the subject a bit but I have been thinking not being the med expert. Yesterday I was talking to a man at Home Depot his nephew in his 40's has intractable depression he said he would get in a car and drive call home and have no iedea where he was. Well he received a rTMS implant and now his depression is basically cured he functions at 80-90%. Have you considered this love Jan
Posted by gardenergirl on April 22, 2006, at 21:28:26
In reply to New Idea Scott, posted by Phillipa on April 22, 2006, at 21:07:20
Scott,
I'm sorry you're experiencing this. It's so frustrating.You're getting some great advice here about meds, and I can't add to any of it. But something else...You may have already considered this, but has there been anything situational going on that could trigger a depression? I ask because I've had depression come back for me, and I've immediately looked to my drug regimen for tweaking. When I met with my pdoc, she pointed out that I had stopped doing some of the behavioral things that had been helping (yoga, light therapy, eating better, etc.) and that I had experienced a number of losses recently. No wonder I was depressed again, she said. So we didn't adjust any meds at that time. I made an effort to go back to doing the things that had helped before, and I tried to deal with the loss issues in therapy. And it eventually passed.
Of course it may truly be poop-out, and that always stinks. But if there's any chance there are psychosocial variables, I just wanted to raise my hand and say, "um..but?"
I share your secret wish.
gg
Posted by SLS on April 23, 2006, at 7:35:35
In reply to Re: Another drug failure, posted by linkadge on April 22, 2006, at 19:08:48
> Nortryptaline will supress REM greatly, but bupropion enhances it.
>
> You might be a good candedate for voldoxan.Antidepressants no longer suppress dreaming for me. Parnate once completely abolished it, now it doesn't affect me at all. All of my exposures to medication have definitely changed the way my CNS works.
I found it difficult to detect any differences in the way I slept during the time I was responding to medication this time around.
I would probably try agomelatine simply because it is different from anything I've yet tried.
I am getting depressed about being so ill. I was tempted to stay in bed all day because I would like to just give up.
- Scott
Posted by SLS on April 23, 2006, at 7:58:29
In reply to Re: Another drug failure, posted by zeugma on April 22, 2006, at 21:01:03
> yes, Ed is correct that I said that Wellbutrin wil raise NOR plasma levels. Wellbutrin is a potent 2D6 inhibitor.
>
> Can you get plasma monitoring of nortrip done on your insurance? I know it's awfully expensive when uninsured.I never thought of that. I guess it is possible that nortiptyline is too high and outside the therapeutic window.
Thanks.
- Scott
Posted by SLS on April 23, 2006, at 8:10:05
In reply to New Idea Scott, posted by Phillipa on April 22, 2006, at 21:07:20
> Scott I know I'm changing the subject a bit but I have been thinking not being the med expert. Yesterday I was talking to a man at Home Depot his nephew in his 40's has intractable depression he said he would get in a car and drive call home and have no iedea where he was. Well he received a rTMS implant and now his depression is basically cured he functions at 80-90%. Have you considered this love Jan
Hi Jan.
It sounds like you might be talking about VNS. I've been following its development, and have not been very enthused by its low success rate. The response rate is about 30% after 8 weeks. However, one must take into consideration that the study population is probably almost entirely treatment resistant. One thing that is important is that the literature indicates that some treatment failures at 8 weeks go on to improve at 6 months to a year.
I don't know what to think. The story you told is very interesting. I guess I'm not ready to have wires routed through my chest and neck with only a 30% probability of success.
As far as rTMS is concerned, if it is approved by the FDA, I will probably try it. They are getting closer to determining the optimal parameters of its application.
Thanks for your input. I guess I can't rule out VNS entirely.
- Scott
Posted by linkadge on April 23, 2006, at 8:38:03
In reply to Re: Another drug failure » zeugma, posted by SLS on April 23, 2006, at 7:58:29
Yeah, the voldoxan might offer a complementary effect to those taking other antidepressants.
If you're more "blue" then it might be a sign that you're one too many catecholamine enhancing drugs.
OTOH, Emsam might be an interesting option, though I don't know of the interaction with the drugs you're taking. Selegeline has a protective and restoritive effects on dopaminergicly mediated functions during aging, did you ever try selegeline?
Linkadge
Posted by SLS on April 23, 2006, at 8:43:28
In reply to Re: New Idea Scott, posted by gardenergirl on April 22, 2006, at 21:28:26
Hi GG.
> I'm sorry you're experiencing this. It's so frustrating.
Being given a taste of real life only to be denied is torturous.
> You may have already considered this, but has there been anything situational going on that could trigger a depression?
Not really. I've been taking advantage of some IP psychotherapy for about 6 months, and there doesn't seem to be anything getting in my way. I have also been using cognitive behavioral strategies to help manage my life for years.
Light therapy sounds like a viable option. A friend of mine who does not exhibit any seasonality to her depression has been benefiting from using it for 30 minutes each morning. I am so tired of investing myself in all sorts of different treatments.
When I respond to treatment, the effect is unmistakable. It is like adding color to a black and white world. This response was the real thing. Unfortunately, my relapse was a true poop-out (tachyphylaxis), and occured in the absence of significant psychosocial stress.
I am starting to get depressed about this treatment failure. I really don't want to be bothered trying to fight it. Having one depression stacked upon the other doesn't make for a pleasant combination. I was counting on this stuff to work. I thought I was on my way...
- Scott
Posted by SLS on April 23, 2006, at 8:50:27
In reply to Re: Another drug failure, posted by linkadge on April 23, 2006, at 8:38:03
> Yeah, the voldoxan might offer a complementary effect to those taking other antidepressants.
>
> If you're more "blue" then it might be a sign that you're one too many catecholamine enhancing drugs.
>
> OTOH, Emsam might be an interesting option, though I don't know of the interaction with the drugs you're taking. Selegeline has a protective and restoritive effects on dopaminergicly mediated functions during aging, did you ever try selegeline?I tried the oral preparation, Eldepryl. I took 30mg. I guess I should really consider the patch, despite my not responding adequately to Parnate and Nardil. I doubt my doctor would let me stay on nortriptyline and Wellbutrin, though.
I really don't feel blue, sad, or melancholy. It is more a loss of interest, anergia, and anhedonia. By what mechanisms do you think too many catecholaminergic antidepressants would produce feeling blue?
Thanks, Linkadge.
- Scott
Posted by ed_uk on April 23, 2006, at 9:43:45
In reply to Re: Another drug failure » linkadge, posted by SLS on April 23, 2006, at 8:50:27
Hi Scott
I hope Valdoxan is approved in Europe soon. Do you think it will be easy for you to obtain?
Regards
Ed
Posted by platinumbride on April 23, 2006, at 9:54:55
In reply to Another drug failure, posted by SLS on April 22, 2006, at 9:11:50
Scott,
I'm so sorry you are going through this again. I wish you the best.
Diane
Posted by bassman on April 23, 2006, at 10:10:50
In reply to Re: Another drug failure » SLS, posted by ed_uk on April 23, 2006, at 9:43:45
Is Valdoxan approved in the US? The only thing I could find on the net were Phase III trials..
Posted by SLS on April 23, 2006, at 10:53:47
In reply to Re: Another drug failure » SLS, posted by ed_uk on April 23, 2006, at 9:43:45
> Hi Scott
>
> I hope Valdoxan is approved in Europe soon. Do you think it will be easy for you to obtain?If the guy is still in business, I have used a pharmacy in the UK to procure sulpiride.
- Scott
Posted by ed_uk on April 23, 2006, at 11:22:46
In reply to Re: Another drug failure » ed_uk, posted by SLS on April 23, 2006, at 10:53:47
Hi Scott
What sort of pharmacy was it?
Ed
Posted by SLS on April 23, 2006, at 11:56:25
In reply to Re: Another drug failure » SLS, posted by ed_uk on April 23, 2006, at 11:22:46
> Hi Scott
>
> What sort of pharmacy was it?Probably a Mom and Pop store. I don't think it was a chain store.
You're not going to tell on me, are you?
:-)
- Scott
Posted by ed_uk on April 23, 2006, at 12:20:20
In reply to Re: Another drug failure » ed_uk, posted by SLS on April 23, 2006, at 11:56:25
Hi Scott
>You're not going to tell on me, are you?
LOL. No!
Ed
Posted by linkadge on April 23, 2006, at 12:28:56
In reply to Re: Another drug failure » linkadge, posted by SLS on April 23, 2006, at 8:50:27
I've heard the theory thrown around somewhere on biopsychiatry.com, that in a state of catecholamine excess one can feel profoundly unsatisfied. Thats where serotonergics come in (or so the theory goes).
Linkadge
Posted by linkadge on April 23, 2006, at 12:48:44
In reply to Re: Another drug failure » SLS, posted by linkadge on April 23, 2006, at 12:28:56
How do you feel about the abilify. The reason I ask is that it does have a strong antagonistic affinity for d3 receptors. These receptors are loaded in pleasure centres of the brain. So I don't know the kind of effect that blocking those would have on anhedonia.
The theraputic effect you're getting from this drug is probably a combination of 5-ht2a antagonism and 5-ht1a agonism, and perhaps d2 agonism.
The combination of dopamine + serotonin agonism is an unexplored terrain. For instance one study showed that (in parkonsons disease) adding gepirone to a dopamine agonist resulted in significant improvements in both movement and depressive symtpoms.
Ie buspar + mirapex.
What about replaceing the abilify with trazodone ?
Lamictal + trazodone + nortryptaline.
It might be cleaner.
Linkadge
Posted by ravenstorm on April 23, 2006, at 13:01:22
In reply to Re: Another drug failure, posted by linkadge on April 23, 2006, at 12:48:44
Scott-
Forgive me if you already tried this. I took a break from the boards for about six months so I'm not up on anything that happened during that time frame.
I remember you being interested in a trial of RU486, did that ever come to fruition? If not, is it a possibility in the near future?
Also, would you consider being in a trial for DBS if it was available. Those reports out of Toronto looked pretty promising.
You are in my thoughts.
Posted by TJO on April 23, 2006, at 15:40:54
In reply to Re: Another drug failure » SLS, posted by linkadge on April 23, 2006, at 12:28:56
Hi Scott,
Hang in there!! :-)Tam
Posted by Jay on April 23, 2006, at 16:46:07
In reply to Re: Another drug failure » ed_uk, posted by SLS on April 23, 2006, at 11:56:25
Posted by SLS on April 23, 2006, at 19:03:35
In reply to Re: Another drug failure..PLEASE READ » SLS, posted by Jay on April 22, 2006, at 15:05:27
Hi Jay.
Thanks for the good ideas.
> So here goes my reccomendations:
>
> -Add another mood stabalizer..possibly a good one, like depakote.I think I'll try adding back the Keppra as a mood stabilizer.
> -You've got stimulating antidepressants, so add some Prozac, at a GOOD dose. (i.e. 80mg's)
Yeah. I never tried more than 20mg a day.
> -Add another atypical antipsychotic. Risperdal seems safest as far as diabetes goes, and don't be afraid to bump around the dose.
I've tried Zyprexa, Risperdal, Seroquel, and Geodon. Low dosages of Risperdal did help, but only for a few weeks.
> -I'd suggest maybe dumping the Wellbutrin, in place of some new Dexedrine.
Maybe I could just add it to the Wellbutrin. I would hate to give up on the Wellbutrin too quickly.
> -Add a PRN benzo if anxiety is still a problem.
I have some social anxiety, but nothing that I would consider paralyzing.
Your suggestions are valid, and I'll keep them in mind for the future. With so many ideas being presented, it is hard to know which ones to choose.
> Good luck...you still have a long road to travel my friend.
You might be right. I hope it is not too much longer. I've waited too long already.
Thanks again.
- Scott
Posted by Phillipa on April 23, 2006, at 20:05:29
In reply to Re: New Idea Scott » Phillipa, posted by SLS on April 23, 2006, at 8:10:05
Scott sorry I did mean VNS. Love Phillipa
Posted by Crazy Horse on April 23, 2006, at 20:56:57
In reply to Re: Another drug failure » SLS, posted by linkadge on April 23, 2006, at 12:28:56
Posted by maxime on April 24, 2006, at 0:27:18
In reply to Another drug failure, posted by SLS on April 22, 2006, at 9:11:50
i'm sorry scott. but there will be more drugs to try. i know that doesn't help you now. I wish I could make you feel better.
love, maxie
> Another drug failure.
>
> The addition of Wellbutrin to my treatment produced a profound improvement in my depression during weeks 3 and 4. No more. I have relapsed. There is no vestige of an antidepressant response. I do not expect one to reappear regardless of how much time I remain on this drug.
>
> I don't know how much more I can take. I don't know what there is left to try. The logical part of me concluded quite some time ago that my brain will never respond to treatment. The emotional part of me masks the logical part and continues to have hope. I probably would not continue to live without it. I must therefore suppress and ignore my logic in order to survive.
>
>
> - Scott
Posted by jedi on April 24, 2006, at 1:20:33
In reply to Another drug failure, posted by SLS on April 22, 2006, at 9:11:50
Hi Scott,
There is probably nothing I can say about your medications that you haven't thought of already. I have been reading your posts since the early days of Babble and I really appreciate the wealth of information you have provided to myself and others. I sure wish there was the magic pill that could take the pain away. All I can say is hang in there like you have in the past; things will get better. Some of us are in this for the long haul.
Take care,
Jedi> Another drug failure.
>
> The addition of Wellbutrin to my treatment produced a profound improvement in my depression during weeks 3 and 4. No more. I have relapsed. There is no vestige of an antidepressant response. I do not expect one to reappear regardless of how much time I remain on this drug.
>
> I don't know how much more I can take. I don't know what there is left to try. The logical part of me concluded quite some time ago that my brain will never respond to treatment. The emotional part of me masks the logical part and continues to have hope. I probably would not continue to live without it. I must therefore suppress and ignore my logic in order to survive.
>
>
> - Scott
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Dr. Bob is Robert Hsiung, MD,
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