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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Alex01 on July 24, 2001, at 5:32:08
Hi all, this is my first post, I have dropped in on the site before and have been impressed by the quality of the information provided, so here goes.
I've had dysthymia all my life which has flared into greater or lesser depressive episodes with anxiety, and occasionally manic espisodes (which have never been psychotic). Key problems are an inability to concentrate and lack of distinct emotional response to outside events. I have tried many different anti-depressants but so far with limited luck.
My father was schizophrenic and died when I was young so I saw some psychs to see if it was a cognitve or emotional sort of problem, but after years of talking, they thought I seemed fine except for some messy brain chemistry.
Anything seretonergic left me feeling very blank (which wasn’t bad given that it wiped away anxiety and depression but left nothing else). I’ve tried all the usual SSRI suspects and Effexor and Serzone. These exacerbated the problem I have with little emotional response to outside events and difficulty concentrating.
Noradrinergic meds succeed in lifting my mood but also leave me feeling blank and unable to concentrate or think clearly, make decisions etc. Have tried effexor, modrafinil, adrafinil and buproprian. I had a bad reaction to burproprian with muscle tenseness, dizyness that felt like I was going to faint which didn’t go away with time.
One psychiatrist thought I was manic depressive and suggested Zyprexa which made me feel heavy headed and dull.
One psych thought I had ADD so I have an amphetamine stimulant a try. I had a tiny chip of a tablet and got very anxious, nauseous and muscle stiffening.
The good news is this: I have had a few episodes when my brain’s reaction to medication (effexor, buproprian and an amino acid dl-phelalanine) seemed to produce a stimulant effect which sharpened my mind, gave me clear and distinct thoughts and responses. These drifted away after a few memorable days.
Questions I want to ask are: what are some future avenues of investigation? Other meds? Physical cause? Anything else? Any suggestions gratefully received.
Posted by SalArmy4me on July 24, 2001, at 6:52:18
In reply to Depression / anxiety - any suggestions?, posted by Alex01 on July 24, 2001, at 5:32:08
Try mirtazapine or desipramine.
Posted by sl on July 24, 2001, at 8:49:42
In reply to Depression / anxiety - any suggestions?, posted by Alex01 on July 24, 2001, at 5:32:08
http://www.dr-bob.org/babble/20010522/msgs/64298.html
Also, I hope you're considering combinations. It may take a certain combo to completely alleviate your symptoms. :)
Luck...
sl
Posted by MB on July 25, 2001, at 1:13:50
In reply to Depression / anxiety - any suggestions?, posted by Alex01 on July 24, 2001, at 5:32:08
< snip >
> One psychiatrist thought I was manic depressive and suggested Zyprexa which made me feel heavy headed and dull.
< snip >
Wow, antipsychotics really are in vogue with the pdocs. I've never heard of using an antipsychotic as a first choice for manic-depressive illness. Although what the hell do I know...
Posted by JohnL on July 25, 2001, at 2:59:26
In reply to Depression / anxiety - any suggestions?, posted by Alex01 on July 24, 2001, at 5:32:08
> Questions I want to ask are: what are some future avenues of investigation? Other meds? Physical cause? Anything else? Any suggestions gratefully received.It always brings me down when I hear that my favorite meds, like Adrafinil or Zyprexa, were not helpful. I hate the saying "mileage varies", but sadly it is so true.
The subtle clues in your post do point to norepinephrine and/or dopamine. The trick is finding just the right chemical molecule to affect those chemistries. I have a hunch that you will likely need the synergistic effects of two meds together, and that no single med alone is going to do the trick.
Zyprexa made you feel dull. I wonder, what dosage was that? And how long were you on it? I ask because I believe the lower doses work best for symptoms like yours. Doses such as 5mg or less. And with Adrafinil, I wonder how long you were on it? For me the benefits accumulated over weeks and months. Though I did feel immediate improvement with either Zyprexa or Adrafinil, I must admit the full effect took time, similar to antidepressants.
Some options to consider: Prozac+Zyprexa. Prozac+Zyprexa+Adrafinil. Prozac+Adrafinil. Risperdal, very low dose (.5mg to 2mg range). Prozac+Risperdal. Even though you may not like the serotonic route, I mention Prozac because it is so different than all the others. It stands alone and in my experience does not resemble the other copycats at all. You may have already tried it. If not, I would consider it.
My favorite suggestion for you though has to be Amisulpride. This is a European antipsychotic that works exclusively on stimulating dopamine D2 receptors. It can work wonders for depression, dysthymia, dullness, anhedonia, anxiety, and social phobias. The only drawback is that it is hard to find. You would have to do some creative online searching with the keywords "Amisulpride" or "Solian" and "farmacia" as well as names of European countries to uncover some possible mailorder sources. They do exist, but it takes some searching and emailing to find them. Your efforts could well be worth it though. This is a wonderful drug.
Another possibility, though lower on my priority list due to side effects, would be the tricyclics Nortriptyline or Desipramine.
And there is also a chance something as simple as 300mg to 600mg of Lithium could work well. I do know of several cases of resistant psychiatric complaints that responded extremely well to Lithium, and very fast. And in these cases, there was no clinical justification at all for trying Lithium. It's just that everything else had already been tried and so there was nothing to lose. It worked miracles and the people wondered why it took so long to come around to it. The reason was of course that there was no clinical justification. However, regardless, it worked wonderfully. Just another option to think about.
I still think your best bet will be some combination of Prozac, Zyprexa, Risperdal, Amisulpride, Adrafinil, or Lithium. Keep in mind that any two of these combined is totally different than the single drug alone. It's like the sum is greater than the parts added together.
John
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