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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by zarathustra on February 13, 2001, at 22:36:43
Please help.
My doctor tells me I am depressed, I have taken Zoloft, paxil, prozac, effexor, serzone, wellbutrin, and manerix.
I had success with paxil, and zoloft, the first time I tried them; I discontinued due to profound sexual side effects, and when I tried again, there was no effect whatsoever.
The other meds had very limited effects; most just gave me a little "taste" of normalcy.Please bare with me, I am having trouble thinking, and remembering the thoughts that were just in my head.
I will give you a little background. I am very smart (99th percentile), so they told me when I was about seven, and doing poorly in school. I was called a daydreamer, lazy, and distant.
I was place in the regional gifted program for 4 years, and consequentially excluded from any of the activities of my peers.
I left the gifted program against my parents wishes, and entered the "mainstream", just about the time I believe I started becomming depressed. I stumbled through high school, eventually dropping out.
I have had 31 jobs since leaving (I am 26 now) I often think that I may suffer from add.My problem is this:
from a young age, I have taken a very "scientific" view of existence, I feel ashamed of being human. We are no different than a plant or an amoeba, in purpose or importance.
Emotions are chemistry. There is no god, no divine purpose, good, or bad. We are ants in ant-hills.
These are not just thoughts; I can't enjoy anything in my life without something comming into my head which diminishes it, or deconstructs it down to molecules. My doctor says I am rationalising my depression, but I seem to refuse to acknowledge that I am even depressed!
I feel that I just see life more profoundly and for what it really is: a farce.I cant think, my judgement is severally impaired (so is my spelling) I feel like I am really going crazy. Everything is so cold.
I sleep about 12-14 hours a day and cant stop eating. I see no future for myself (I cant even see beyond tommorow).
My mind is mush.Apparently, i may be sufferening from partial complex seizures as well, I have these dream like deja-vu every few months in which I smell my hands and enter a kind of "dream like" state (conciousness not impaired).
I also shake pretty badly sometimes, and anger attacks are becomming more frequent.ANYWAYS, i feel quite ashamed for expressing all of this, my hope is that somone can recomend a med, or somehow link together all of my malfunctions.
I am going to request a tca from my doctor, as I have never tried them before.Please help, I really don't know what to do, I'm losing hope.
Andrew.
Posted by JohnL on February 14, 2001, at 2:26:17
In reply to running out of options, posted by zarathustra on February 13, 2001, at 22:36:43
There are still plenty of options. More than enough to keep you busy for years and years. However, it shouldn't take that long.
Usually when people stop antidepressants, and then restart them again only to discover they don't work as well the second time around, must end up taking more than one drug to achieve full response. In your case, something tells me an antipsychotic combined with your favorite antidepressant could be worth exploring. Tricyclics too, though the side effects are troublesome.
I noticed lots of little clues and hints in your post. They all pointed in one direction....Zyprexa. I wouldn't try it by itself though. Instead, combine it with your favorite antidepressant so far.
That would be my top pick for your next move. There are plenty of others.
John
Posted by SalArmy4me on February 14, 2001, at 5:01:52
In reply to running out of options, posted by zarathustra on February 13, 2001, at 22:36:43
Before you think about Luvox, you should know that you have many other options. I myself was going to do ECT, and then I found relief in a newer drug called Mirapex. Here are some more options you may not have thought of:
Lamotrigine - good side-effect profile; most antidepressant properties
Carbamazepine - less side effects than Lithium or divalproex sodium
Topiramate - the newest mood-stabilizer; it promotes weight loss
Desipramine - the least side-effects of all the Tricyclics; one of the SNRIs
High-dose Venlafaxine - at higher doses Venlafaxine affects more chemicals than SSRIs.
Buspirone - an effective antidepressant and anxiolytic at high doses.
Dopamine Agonists - Pramipexole has two studies on it (I take it).
"Power Combinations" - mirtazapine + venlafaxine; Buproprion+Mirtazapine, Mirtazapine + fluoxetine
Augmentation of anything you have tried before with Lithium, Pindolol, or Buspar (i took pindolol
Foreign medications to the US: the RIMA Moclobemide; Reboxetine; Amisulpride, etc
Atypical Neuroleptics/Antipsychotics with antidepressant properties: Risperidone, Olanzapine, Quietapin
Modafinil - a stimulant that is possibly effective
Irreversable MAOIs - Phenelzine, Tranylcypromine. Extremely Effective.
MAOI-B - Selegiline
I hope that gives you some hope! No ECT!
Posted by ChrisK on February 14, 2001, at 5:35:57
In reply to running out of options, posted by zarathustra on February 13, 2001, at 22:36:43
I agree with the above posts. I didn't react to SSRI's but did find hope with the TCA's. I currently take Nortriptyline but was OK on Imiprimine also. The first thing to help was Zyprexa. It brought me out of a very suicidal funk. I still take it a couple of years later and find that I notice a mood change if I miss more than 2 doses.
This year I have added Mirapex and find it the best thing to happen since I started the Zyprexa. It has really helped with my anhedonia and apathy. I feel more alive than I have in a long time.
Judging from your story I would suggest that you start by asking your doctor for an anti-psychotic like Zyprexa. I found that it really cleared up my negative thinking. If it will work you will probably know within a week. It's worth a try.
Chris
Posted by Noa on February 14, 2001, at 11:23:19
In reply to Re: running out of options, posted by ChrisK on February 14, 2001, at 5:35:57
I agree there are still lots of options. Your feeling like you are running out of them reflects the depression, imho. I know that when I am depressed, I get caught up in existential questions, too, obsessing about the meaninglessness of life, etc. It is true, a lot of what constitutes happy human existence doesn't stand up very well to the kind of inquiry you are talking about---everything can be reduced to molecules. But if you weren't depressed, you just wouldn't care so much about that, and would be able to experience some better moods, and have some pleasure.
The suggestion of an antipsychotic like zyprexa might make sense because, from what I read here, lots of people who find themselves "thinking too much", ie, caught up in the whirlwind of neverending negative thoughts, seem to have found relief by using this med or others like it.
Also, from your history, the question of ADD kind of pops out: history of school problems from age 7, difficulty staying with anything for very long.
You sound depressed to me, too(hopelessness, feeling life is meaningless,etc). But---if you don't feel depressed, can you describe what you do feel? What gives you joy? Has anything in your life ever given you joy?
Also, since you focus on rational, intellectual ways of seeing the world, I wonder if you have had any difficulties reading other people's emotions? Reading social cues? What was it like when you were a kid to make or keep friends? Do you like being with people? Have you ever liked it but don't now?
These are just a few questions that came up as I was reading your post.
Posted by Noa on February 14, 2001, at 11:26:13
In reply to Re: running out of options, posted by Noa on February 14, 2001, at 11:23:19
Have you seen a neurologist about the possible siezures? I believe that people with siezure disorders are at risk for depression, too.
Posted by zarathustra on February 14, 2001, at 16:01:27
In reply to Re: running out of options, posted by ChrisK on February 14, 2001, at 5:35:57
I have noticed from the responses to my posting that most think I should try Zyprexa.
I was under the impression that I suffer from depression: Why would I consider a mood stabiliser or anti-psychotic?Does my posting suggest symptoms of these?
Also, what exactly is anhedonia and anergy(anergic)
Andrew.
Posted by ChrisK on February 15, 2001, at 5:43:16
In reply to WHY ARE PEOPLE RECOMMENDING ZYPREXA?, posted by zarathustra on February 14, 2001, at 16:01:27
I wouldn't get hung up on the term antipsychotic. Zyprexa has been studied and been shown to be a good augmenter for depression, even at low doses. It sounds like you need something to clear your thought patterns and I know that Zyprexa did just that for me. Since I've started taking it I can think more clearly and rationally. Yourpost makes it sound like you woulld benefit from the effects of this med.
Also, Anhedonia is a lack of joy in your life. Things that used to be enjoyable aren't any longer. This is usually refering to sex but also includes any hobby that you liked at one time such as reading, sports, cooking, etc.
Anergy is the lack of energy. You don't feel like getting out of bed to do anything.
It is common to target these symptoms with something other than going solo with an antidepressant.
Hope this helps.
Chris
> I have noticed from the responses to my posting that most think I should try Zyprexa.
> I was under the impression that I suffer from depression: Why would I consider a mood stabiliser or anti-psychotic?
>
> Does my posting suggest symptoms of these?
>
> Also, what exactly is anhedonia and anergy(anergic)
>
> Andrew.
Posted by Sulpicia on February 15, 2001, at 19:43:52
In reply to running out of options, posted by zarathustra on February 13, 2001, at 22:36:43
> Hey Z. [sorry I really wanted to type "Thus Spake"]--
I've been treated for serious depression 3x and this last round
coincided with my son being evaluated for ADD/HD. For every "no"
we answered for him, I silently answered "yes" for myself. I finally
got myself evaluated and dxed and treated with adderall, along with
tofranil for the depression.The more I learn about ADD [no hyper for me], the more I understand
how often it's co-morbid with, or perhaps in some sense causative, of
depression. I'm smart on paper, did well in school but certainly had
more than my share of troubles, especially in college and now in grad
school. I knew something was wrong, it had to do with learning or intelligence,
or so I thought. In a million years I would never have guessed ADD.Scientific view of emotions et al??? Oh boy, this is classic. People with
ADD can't *read* other people's emotions very well, or at all. We respond
inappropriately and we tend to think in very unusual ways. Thinking outside
the box is great if you're writing a dissertation in theoretical physics,
but terrible if you want a date for the weekend. Fitting in as a child or teen?
Possible but unlikely.Numerous jobs??? We start things [millions of things] and never finish.
We are impulsive and combined with the above social difficulties, numerous
jobs or multiple careers are a reality.Mood lability, anger, inability to concentrate, follow rules, make habits, etc.
are all part of what I experience with ADD and depression.I'm not sure about your seizure experience [never experienced one or seen one]
but when my depression gets very severe, I experience olfactory hallucinations.
Garbage, in fact, and NYC summer garbage to be precise. Go figure.Two thoughts: nobody can diagnose you online but how about reading up on ADD?
If you go to the ADD site home at About.com, you'll find a ton of good info, some
online diagnostic material to give you some idea of what I'm talking about, and you
might try reading a few of the threads in the forum to see if anything hits home.The other thing I can add is that the SSRIs tend to augment the effect of psycho-stimulants
and my TCA, tofranil, dampens the effect a bit.I've had excellent results with tofranil; was talked into Paxil once -- it worked but it did
something weird to my muscles so I couldn't run, AND gave me intense sugar cravings so no go.
Last thought -- if you are tall and/or have low blood pressure, TAKE CARE standing up with the
TCAs -- the warning about sudden drops in blood pressure on rising is very accurate.Good luck to you,
S.
Posted by JohnL on February 16, 2001, at 4:32:48
In reply to WHY ARE PEOPLE RECOMMENDING ZYPREXA?, posted by zarathustra on February 14, 2001, at 16:01:27
> I have noticed from the responses to my posting that most think I should try Zyprexa.
> I was under the impression that I suffer from depression: Why would I consider a mood stabiliser or anti-psychotic?
>
> Does my posting suggest symptoms of these?
>
> Also, what exactly is anhedonia and anergy(anergic)
>
> Andrew.Hi Andrew,
You ask a good question. Why try antipsychotics or mood stabilizers for depression? Here's my thinking on that.Depression is often linked to a brain chemical imbalance, of which there are at least 10 general categories of different types of chemical imbalances. Antidepressants only address 3 of those 10 chemical imbalances. For example, if a doctor only uses antidepressants to treat depression patients, that doctor is assuming that all depressions are caused by low serotonin and/or norepinephrine. That just isn't so. The brain is way more complicated than that. There are many chemistries involved in depression, many of which have absolutely nothing at all to do with serotonin. And thus the disappointing results with antidepressants sometimes.
I do not look at drugs as antidepressants, antipsychotics, or whatever. Instead, I look at them as different types of brain chemical manipulators. Each different category of drugs targets different chemistries. For example, I look at SSRI antidepressants as serotonin enhancers. Tricyclics are serotonin and norepinephrine enhancers. Depakote is a chemical stabilizer. Lithium is an electrical stabilizer. Antipsychotics are dopamine manipulators (among other things). And such. This is an overly broad and overly simple way to look at it, but it does however allow one to categorize different causes of depression and match a particular medication to that cause.
Setting my views and opinions aside for a moment, it is worth mentioning that clinical studies are rich in evidence supporting the use of antipsychotics and mood stabilizers for treating depression. This is especially true when antidepressants alone have not provided desired results. It's simply a matter of targeting the real underlying root chemical cause of the depression. Antidepressants only target 1/3 of the possible causes.
John
Posted by krista on June 10, 2001, at 17:40:37
In reply to running out of options, posted by zarathustra on February 13, 2001, at 22:36:43
> Andrew,
I feel the same way, I have been depressed since I ws 5. Barely made it out od school. Have never been able to hold a job.
I also have the same feelings toward life and the world as you do. I wish I could be more postive about things.
Antidepressants help a little to curb the depression, but I still feel it. I used to lie there in bed everyday for hours staring at the celing
in almost physical pain from the depression. It's the worst feeling in the worls, you feel like death wont even take away the pain.. You scream and cry
but it doesn't go away. I have tried lots and lots of antidepressants and none
allow me to lead a normal life. I don't know what to do anymore. I can't live in this world without being able to support myself. I feel that this world is too hard for sick peoplekrista
Posted by PuraVida on June 13, 2001, at 13:57:41
In reply to Re: running out of options, posted by krista on June 10, 2001, at 17:40:37
Hi Krista,
I noticed your post, and wanted to respond, though I don't know how much help I'll be. A lot of people on this board are struggling to get their meds right, but I think on the other "social" board there is probably more support emotionally from folks that have or are dealing with thier depression better than I am right now.
I, too, suspect I've had depressive tendencies since I was 5. I used to cry and cry, and have physical stomach pain every morning, even though I really did love my school. Same thing has reoccurred in my life, I've been through many, many jobs, relationships, etc. When I am really depressed, I see only the what-ifs - how I could have done better, what "should" be, "if only this, or that." When I think this way I KNOW I'm depressed. I can say this now because, right now, I'm not, but I have been in and out of it enough to know that those thoughts are NOT rational. Life is NOT that hard, it is the depression making you think so. You've survived this far, and I'm sure you've had some wonderful times somewhere in your life, under all the gloom.
My goal, at the moment, is to accept that I am sick, and that like all of the other sick people in the world, I can do my best with what life has dished out. If that means lying in bed till noon, I try to be easier on myself than a "normal" person, because to be hard on myself with "shoulds" will only get me more depressed. I think everyone in the world has some sort of challenge in their lives - really, no one is "normal"
What kinds of meds are you on? I've found some success with alternative methods, in addition to the meds - mainly cognitive therapy, doing volunteer work, getting a hobby and taking care of myself physically. I'd be happy to share.
> > Andrew,
>
> I feel the same way, I have been depressed since I ws 5. Barely made it out od school. Have never been able to hold a job.
> I also have the same feelings toward life and the world as you do. I wish I could be more postive about things.
> Antidepressants help a little to curb the depression, but I still feel it. I used to lie there in bed everyday for hours staring at the celing
> in almost physical pain from the depression. It's the worst feeling in the worls, you feel like death wont even take away the pain.. You scream and cry
> but it doesn't go away. I have tried lots and lots of antidepressants and none
> allow me to lead a normal life. I don't know what to do anymore. I can't live in this world without being able to support myself. I feel that this world is too hard for sick people
>
> krista
Posted by Zo on June 16, 2001, at 21:03:30
In reply to Re: WHY ARE PEOPLE RECOMMENDING ZYPREXA?, posted by JohnL on February 16, 2001, at 4:32:48
The way my pdoc (behavioral med) explained it to me, Zyprexa blocks the flood of dopamine to the limbic systems of any kind of hyperarousal -- longterm stress, that flood which so befogs the perceptions, upsets the emotions, makes the container of the self so fragile. . .And in much smaller doses than its use as an antipyschotic. Cleared my thoughts dramatically. . .after ten years of various med cocktails.
Downside: gained 30 lbs. It's now recommended to take Axid twice a day to prevent. Too late for me. . .am now slooooowly switching to Geodon, hoping for same good effect.
This is the end of the thread.
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