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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by med_empowered on July 28, 2005, at 16:05:45
hey everyone. I'm a 21 year old guy with severe, recurrent bouts of depression--sometimes also hypomania, possibly mixed-episodes--along with insomnia, anxiety, and, rarely, psychotic symptoms with more extreme mood episodes. As you can probably tell from my previous posts, I'm kind of displeased with the kind of treatment that is offered in psychiatry. Still, I need to do something. I'm more or less out of a pretty bad depressive episode (lots of insomnia, mild psychotic symptoms), but for the past couple months I've been so incredibly tired and fatigued. Sometimes I literally sleep the day away. I dont know what to do. Antidepressant used to help with my depression when I was younger, but they dont really seem to do very much now. Stimulants are OK, but I hate feeling wired and hyperfocused; plus, I'm sensitive to the cardiovascular effects of stimulants and other meds, so they can wreak havoc. Neuroleptics have been unsatisfactory; the best was low-dose abilify with an antidepressant and a few other meds...for a week or two, I felt GREAT...not manic or wired, just happy and productive. However, the dose increased, the side effects increased, and I started getting more of the ill-effects associated with neuroleptics (lack of motivation, apathy, fatigue, cognitive impairment, tremor, "neuroleptic induced dysphoria"). I just dont know what to do anymore...I feel as if my life is slipping by me and I'm wasting my youth, but I'm just so TIRED--im also unhappy, but the fatigue and apathy is far more problematic than my sense of despair. What do I do? I've kind of reached the point where I occasional consider suicide as a real alternative...I weigh the pros and cons, think about different methods, that kind of thing. I'm not mentioning this for attention, and please don't think I'm suicidal or anything, I just need to emphasize that I'm EXHAUSTED--I'm fatigued, and I'm tired of constantly dealing with bouts of ups and downs (more downs than ups) that disrupt my life and keep me from being happy. Please...if you have any suggestions, post them. Thanks.
Posted by Meri-Tuuli on July 28, 2005, at 16:24:58
In reply to *PLEASE* help, posted by med_empowered on July 28, 2005, at 16:05:45
Oh honey I don't really know what to say, other than i can sympathize with you..... I do think that you will get better, I don't know how, or when......I just wish I could help!
xx
Posted by ed_uk on July 28, 2005, at 17:00:18
In reply to *PLEASE* help, posted by med_empowered on July 28, 2005, at 16:05:45
Dear Med,
>the best was low-dose abilify with an antidepressant and a few other meds...for a week or two, I felt GREAT...not manic or wired, just happy and productive. However, the dose increased, the side effects increased........
Could you try a low dose again?
>other medication
I remember you saying that you didn't want to take lithium or an MAOI. Why? Have a look in the p-babble archives and see how many people have benefitted from Nardil and Parnate. High doses of lithium seem remarkably unpopular! I've only heard of a couple of people who've liked being on high doses of Li. Low doses are another story, many people seem to benefit from very low doses of Li with minimal side effects. Some people seem to like Li at doses which produce blood levels below the standard range. Barbaracat treats her Bipolar I with a blood level of 0.3. Rod takes 225mg Li for depression with very few side effects. He even finds it a bit stimulating....in a good way :-)
Kind regards
~Ed
Posted by linkadge on July 28, 2005, at 17:33:16
In reply to Re: *PLEASE* help » med_empowered, posted by ed_uk on July 28, 2005, at 17:00:18
Perhaps an MAOI and a low dose atypical.
Linkadge
Posted by xbunny on July 28, 2005, at 17:57:23
In reply to *PLEASE* help, posted by med_empowered on July 28, 2005, at 16:05:45
Sorry to hear your having a hard time you sound like a really intelligent and pleasant guy, I know just how it feels to feel like your life is slipping away whilst you battle illness.
If I were you I might try some more low dose antipsychotic and antidepressant combos. Since low dose abilify was a partial success I would start with that. Theres lots to try so dont give up hope remember to try all dose combinations, I try to keep a mental chart of how much something worked and what the problems with it were so I can keep coming up with combinations and doses, I have even in my more geeky times been known to draw venn diagrams and graphs to try to find suitable ideas from the overlap of effects - bit of a headscrew when your feeling ill though.
Personally I really recommend mirtazapine as an antidepressant to combine with an antipsychotic. I think one reason is that its so good for sleep - not sleeping all the time knackered sleep but quality restful sleep - I think it combines well since it doesnt seem to potentiate the antipsychotics. I took effexor then clomipramine with zyprexa and I felt both intensified the bad effects (akathasia, emotional blunting etc) of the zyprexa - not so with mirtazapine.
If they work for you then a benzo like diazepam might be a helpful addition to an antidepressant also.
An off the wall thing to investigate might be amoxapine since you have depression, insomnia and some psychosis amoxapine might target them all.Dont give up hope, As a guru used to say, "what the mind can conceive, the body will acheive."
Best Regards, Bunny
Posted by Declan on July 28, 2005, at 19:38:28
In reply to *PLEASE* help, posted by med_empowered on July 28, 2005, at 16:05:45
So you've had insomnia but not at the moment? If you didn't have insomnia, if you slept heaps you might try Parnate. But you'd be worried, I guess that it would destabalize you (psychosis, hypomania). You seem intolerant of neuroleptic induced dysphoria so your options there are limited, but maybe some low dose atypical?. Yeah, I dunno, I can't help myself. I really just wanted to say how much I've enjoyed reading your humane and informative posts. So look after yourself and good luck medE, we need people like you around here.
Declan
Posted by Phillipa on July 28, 2005, at 20:10:37
In reply to Re: *PLEASE* help, posted by Declan on July 28, 2005, at 19:38:28
Hi Med, I never would have guessed that you were having such severe problems. Your posts always contain so much information that you appear a genius. The only advise I have or rather question is how do you know what's working or not working with so many med combos? Fondly, Phillipa
Posted by Racer on July 28, 2005, at 22:18:46
In reply to Re: *PLEASE* help, posted by Phillipa on July 28, 2005, at 20:10:37
Have you tried Provigil for the lethargy? I have been taking it for about a year and a half now, and even though it really isn't great for the sluggishness I'm experiencing now, it definitely augments my antidepressants -- in fact, on its own it helps boost my mood enough that I could almost use it alone as a maintainance med.
And, it does help a bit with wakefullness and focus.
Otherwise, I don't know what to suggest to you. I assume you've tried Wellbutrin? That's my friend...
Good luck.
Posted by med_empowered on July 29, 2005, at 0:37:35
In reply to Re: *PLEASE* help, posted by Racer on July 28, 2005, at 22:18:46
Hi! Thanks for the outpouring of help. I really appreciate it. Its kinda funny, really...I'm really interested in psychiatric treatments, so I know more than the average patient, I guess...but when it comes to my own problems, I seem to run into lots of failures and a few partial succeses. *sigh* Starting tomorrow, I'm going to start with the basics--improve my diet a little, get some more exercise, that kind of thing-- and see if a little bit of that takes the "edge" off my problems. I imagine it will help. I'm also reading "Man's Search for Meaning," which I usually do when I feel down...its really helpful and uplifting; I recommend it to everybody. Thanks again everyone!
Posted by SLS on July 29, 2005, at 7:46:40
In reply to *PLEASE* help, posted by med_empowered on July 28, 2005, at 16:05:45
Hi M_E.
Perhaps the best place to start is to consider which mood stabilizers you are willing to try to be used as augmentors to antidepressants. At this point in time, I am partial to Trileptal, Lamictal, and Depakote. Low-dosage lithium might be an effective augmentor to an antidepressant, but I doubt on its own it will be helpful at full bipolar dosages.
Parnate might be the best choice of antidepressant to add to a mood stabilizer. It is usually a better choice for bipolar depression and pretty clean as far as side effects go. Postural hypotension is usually the most prominent, but I have always found it to mitigate over time.
Since I don't know what else you have tried, I don't know whether you feel ready to move on to an MAOI. Parnate + Lamictal or Parnate + lithium have been reported to be particularly successful. My own trepidation regarding the use of Lamictal is that it is not a very good antimanic for bipolar I. I don't know if it would be equally impotent with bipolar II, which is what it seems you suffer from. I would probably go ahead with the Parnate + Lamictal and perhaps use a second mood stabilizer (anticonvulsant or neuroleptic) if hypomania becomes problematic.
Good luck.
- Scott
Posted by Alvin on July 30, 2005, at 11:43:31
In reply to *PLEASE* help, posted by med_empowered on July 28, 2005, at 16:05:45
Hi, my dx is similar to yours and I've had similar experience as you with Abilify and will see my pdoc today to see what he suggests and then I'll get back to you. I liked Abilify best of all the meds I've taken over the years, but experienced bad body muscular pain and anxiety toward the the end of the 5 weeks I was on it. I can only tolerate a low dose of abilify when it was working at its best for me (2.5 mg). I'll see what the pdoc thinks about going down to 1.25 mg and combining with something else....
Posted by Alvin on July 30, 2005, at 18:44:28
In reply to *PLEASE* help, posted by med_empowered on July 28, 2005, at 16:05:45
I re-read your message and it sounds like your diagnosis is more severe than mine; however, after speaking with my pdoc he is suggesting a combo of Geodon with requip (the latter to improve focus and alertness, and to help quell anxiety. _ I haven't tried it yet, but perhaps this is a combo you might want to try.
> hey everyone. I'm a 21 year old guy with severe, recurrent bouts of depression--sometimes also hypomania, possibly mixed-episodes--along with insomnia, anxiety, and, rarely, psychotic symptoms with more extreme mood episodes. As you can probably tell from my previous posts, I'm kind of displeased with the kind of treatment that is offered in psychiatry. Still, I need to do something. I'm more or less out of a pretty bad depressive episode (lots of insomnia, mild psychotic symptoms), but for the past couple months I've been so incredibly tired and fatigued. Sometimes I literally sleep the day away. I dont know what to do. Antidepressant used to help with my depression when I was younger, but they dont really seem to do very much now. Stimulants are OK, but I hate feeling wired and hyperfocused; plus, I'm sensitive to the cardiovascular effects of stimulants and other meds, so they can wreak havoc. Neuroleptics have been unsatisfactory; the best was low-dose abilify with an antidepressant and a few other meds...for a week or two, I felt GREAT...not manic or wired, just happy and productive. However, the dose increased, the side effects increased, and I started getting more of the ill-effects associated with neuroleptics (lack of motivation, apathy, fatigue, cognitive impairment, tremor, "neuroleptic induced dysphoria"). I just dont know what to do anymore...I feel as if my life is slipping by me and I'm wasting my youth, but I'm just so TIRED--im also unhappy, but the fatigue and apathy is far more problematic than my sense of despair. What do I do? I've kind of reached the point where I occasional consider suicide as a real alternative...I weigh the pros and cons, think about different methods, that kind of thing. I'm not mentioning this for attention, and please don't think I'm suicidal or anything, I just need to emphasize that I'm EXHAUSTED--I'm fatigued, and I'm tired of constantly dealing with bouts of ups and downs (more downs than ups) that disrupt my life and keep me from being happy. Please...if you have any suggestions, post them. Thanks.
Posted by sdb on August 1, 2005, at 18:13:20
In reply to *PLEASE* help, posted by med_empowered on July 28, 2005, at 16:05:45
Hi med_empowered,
I do not know your exact drug history. But I am sure there is a solution. I can understand you and all sufferers in this forum can understand you too. All sufferers here have similar problems. Some people in this forum can probably help you.
I can not give you appropriate recommendations and it does not make any sense to force something to somebody. I think that some things are probably good:
-talking with a friend, family or if there is nobody find somebody understandable
-leave the house and go walking or even jogging, I personally go swimming in a small lake...there is some freedom.
-Find an understandable psychiatrist and change immediately if he dont understand you or you feel that he misuse his power. Tell him your true history
-Probably there could be some other physical problems in your body (tiredness...). Check that with an endocrinologist or specialist in internal medicine
-Sometimes its not good to think to much about life. Dont compare with others accept yourself as
unique, worthy human being.You are not alone (!), I think life means generally suffering and that state (that state we know) begins with birth and dead.
In compassion
sdb
Posted by sdb on August 1, 2005, at 18:23:12
In reply to Re: *PLEASE* help, posted by sdb on August 1, 2005, at 18:13:20
I beg you pardon :-)
...birth and <ends> with death.
Isn't it comical my english?
sdb
This is the end of the thread.
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