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Dr. Bob is Robert Hsiung, MD,
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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
Posted by scatterbrained on April 24, 2006, at 2:20:03
In reply to Another drug failure, posted by SLS on April 22, 2006, at 9:11:50
I can relate to trying to supress reality for hope. I wish I could offer some medication suggestions but I'm in the same boat.
Have you tried one of those cbt workbooks? I've found them to be more beneficial than one on one therapy. You strike me as lucid enough to respond to it because you are able to work.
I've found that when medication gets me to the point of being lucid, the three things that offer me a full remission are preductivity, those cbt workbooks and exercise.
I hope this helps and at least you are not the only one suffering.
Posted by SLS on April 24, 2006, at 8:43:50
In reply to Re: Another drug failure » SLS, posted by scatterbrained on April 24, 2006, at 2:20:03
> You strike me as lucid enough to respond to it because you are able to work.
I wish I were. I haven't worked since April 15, 1990. If I can get 50% better, I probably could.
I've never seen a CBT workbook, but I use CBT tools in my day to day life. I have to recognize and "undo" the automatic thoughts that depression produces. Depression taints perceptions and interpretations. It is an unending task to prevent them from becoming internalized.
- Scott
Posted by SLS on April 24, 2006, at 8:49:27
In reply to Re: Another drug failure, posted by SLS on April 24, 2006, at 8:43:50
I have this nervous feeling in the pit of my stomach. I have reached the point where I feel I am doomed to never be free of this ubiquitous cognitive suppression and painful affective oppression. My thoughts turn towards autoeuthanasia.
- Scott
Posted by Crazy Horse on April 24, 2006, at 9:17:55
In reply to Re: Another drug failure, posted by SLS on April 24, 2006, at 8:49:27
> I have this nervous feeling in the pit of my stomach. I have reached the point where I feel I am doomed to never be free of this ubiquitous cognitive suppression and painful affective oppression. My thoughts turn towards autoeuthanasia.
>
>
> - Scott
>
>
I'm sorry that you have to feel this way. It's horrible, i've felt like that many times myself. Do you have and local physical support Scott? A wife, parents, siblings, friends, someone you can lean on to help you at this time? Have you considered being hospitalized? I Just don't think being alone is good.Monte
Posted by SLS on April 24, 2006, at 9:33:26
In reply to Re: Another drug failure » SLS, posted by Crazy Horse on April 24, 2006, at 9:17:55
> > I have this nervous feeling in the pit of my stomach. I have reached the point where I feel I am doomed to never be free of this ubiquitous cognitive suppression and painful affective oppression. My thoughts turn towards autoeuthanasia.
> I'm sorry that you have to feel this way. It's horrible, i've felt like that many times myself. Do you have and local physical support Scott? A wife, parents, siblings, friends, someone you can lean on to help you at this time? Have you considered being hospitalized? I Just don't think being alone is good.
I go to a clinical 2-3 times a week for psychological and emotional support. I almost don't want to be bothered going today, but I guess it would be good for me.
I still can't believe this stuff just stopped working for me. I thought that after two weeks of improvement, I would be home-free. My outlook was positive and optimistic. I was beginning to plan my future as a healthy adult. It all came crashing down on me last week.
- Scott
Posted by jparsell82 on April 24, 2006, at 9:45:21
In reply to Re: Another drug failure » Crazy Horse, posted by SLS on April 24, 2006, at 9:33:26
Have you tried adding a dopamine agonist? I found Trivastal to feel a lot better than Requip or Dostinex. Perhaps you could give Trivastal a try?
Posted by ed_uk on April 24, 2006, at 13:01:41
In reply to Re: Another drug failure, posted by SLS on April 24, 2006, at 8:49:27
Scott,
Are you going to try 450mg Wellbutrin? Perhaps you could decrease your nortriptyline first then increase the Wellbutrin?
Regards
Ed
Posted by SLS on April 24, 2006, at 14:52:25
In reply to Re: Another drug failure » SLS, posted by ed_uk on April 24, 2006, at 13:01:41
> Scott,
>
> Are you going to try 450mg Wellbutrin? Perhaps you could decrease your nortriptyline first then increase the Wellbutrin?That's not a bad idea. I see my doctor on Wednesday. I might skip tonight's dose of nortriptyline to see how I feel tomorrow. Wellbutrin is supposed to be only mild as an inhibitor of 2D6, but I guess it only takes a little to make a big difference.
Thanks.
- Scott
Posted by ed_uk on April 24, 2006, at 16:57:18
In reply to Re: Another drug failure » ed_uk, posted by SLS on April 24, 2006, at 14:52:25
Hi Scott
>That's not a bad idea.
Thank Zeugie :)
Perhaps you could decrease nortriptyline to 75mg as you increase Wellbutrin to 450mg?
Ed
Posted by Cairo on April 24, 2006, at 21:50:52
In reply to Another drug failure, posted by SLS on April 22, 2006, at 9:11:50
I agree that drug interactions might be a place to start:
http://www.healthyplace.com/COMMUNITIES/depression/treatment/antidepressants/lose_effectiveness.asp
http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=338Cairo
Posted by exquilter on April 24, 2006, at 23:38:49
In reply to Re: Another drug failure, posted by Cairo on April 24, 2006, at 21:50:52
Scott,
A consulting Pdoc I saw at the Mayo Clinic years ago reminded me that there are millions of permutations of drug combinations, and that some are bound to work for any given person. Please don't give up yet. Please remember that healing is not a linear process, and we are all hoping you will feel better soon.
Exquilter
Posted by zeugma on April 25, 2006, at 18:10:18
In reply to Re: Another drug failure, posted by exquilter on April 24, 2006, at 23:38:49
hi Scott, I have seen Wellbutrin-induced dysphoria at close proximity and also know that you once had a dysphoric reaction to it.
if the response is similar this time, then perhaps it is simply not a drug that agrees with you.
do you have a history of consistent responses to drugs (i.e., dysphoric vs. minor improvements)?
-z
Posted by SLS on April 26, 2006, at 6:56:53
In reply to Re: Another drug failure, posted by zeugma on April 25, 2006, at 18:10:18
Hi Z.
I experienced dysphoria with Wellbutrin on the several occasions I tried it in the past. This time was different, though. The initial dysphoria was mild and transient. I also experienced anxiety with it this time around that I had not in the past.
My response to the addition of Wellbutrin followed a pattern similar to those I've had with antidepressants in the past. Two to three weeks after starting an antidepressant, I begin to improve markedly. This will last for 3 days to a week. I then relapse. I cannot recapture the antidepressant effect regardless of dosage adjustments and length of trial. This has been going on since 1982.
My brain seems to be very efficient at maintaining an abnormal homeostasis.
- Scott
> hi Scott, I have seen Wellbutrin-induced dysphoria at close proximity and also know that you once had a dysphoric reaction to it.
>
> if the response is similar this time, then perhaps it is simply not a drug that agrees with you.
>
> do you have a history of consistent responses to drugs (i.e., dysphoric vs. minor improvements)?
Posted by denise1966 on April 26, 2006, at 16:20:19
In reply to Re: Another drug failure » ed_uk, posted by SLS on April 24, 2006, at 14:52:25
Scott,
Never say never, there's always non medication options like this DBS, that sounds really promising to me and the good thing about it is that if it's going to work it seems to work straight away.
I know that one day you'll post on this board with a triumphant note saying "ureka!"
Denise
Posted by zeugma on April 26, 2006, at 18:03:36
In reply to Re: Another drug failure » zeugma, posted by SLS on April 26, 2006, at 6:56:53
hi Scott,
it sounds incredibly frustrating, not to mention dispiriting, to go through that pattern again and again.
My brain seems to be very efficient at maintaining an abnormal homeostasis.>>
on the other hand, you are resilient, likely for the same reason.
have your pdocs ever discussed the implications of your pattern of response with you? Perhaps a researcher who specifically focused on patterns of response to antidepressants and related meds might have some useful clues, particularly since the pattern appears so strong (unfortunately).-z
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