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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by deniseuk190466 on January 3, 2007, at 13:08:29
To coin a Radiohead song.
I just sometimes wonder where the me I knew and felt comfortable with went.
At the age of 17 I started feeling as though I was sickening for something, after repeated visits to the doctor for blood tests and xrays he finally told me that there was nothing wrong with me and just to go away and get on with it. Which is what I did.
Then at 24 I started to feel worse, waking up at 4am in the morning everyday, inspite of working, swimming every other night I felt worse and worse. Finally in the doctors office I broke down in tears and he prescribed antidepressants.
At that point I'd never heard of antidepressants, didn't know they existing and didn't want to take any drugs for mental illness because as far as I was concerned I was physically ill not mentally ill.
Then after waking up at 4am in the morning again and feeling terrible and succumbed to taking a small amount of prothiaden.
After taking it, all of the tightness in my muscles seemed to go away and in 24 hours I felt like I'd metamorphised from a catapillar into a butterfly. I was relieved that the physical symptoms had gone away but never anticipated that mood would lift too.
10 years down the line I came off all antidepressants and felt ok, still felt like myself and carried on that way for three years, depression was something I'd forgotten about and something associated with my younger years. In any event if it ever came back I'd just go back on a small amount of seroxat again and after three weeks everything would be ok. My ignorance and naivety was bliss.But that was not what happened, the symptoms came back and although I carried on, telling myself I just needed a holiday. The holiday turned out to be a holiday in hell because that was where my head was at.
So back on the Seroxat I went, only this time, they made the anxiety worse instead of better and so for two years I cycled on and off different drugs to no avail, only knowing that I had to keep trying medication because I had nothing to lose. I did spent 3 months not taking anything and that too was hell so I never blamed the meds for making me feel bad.
Then after two years the Seroxat seemed to start working, although never as much so and to some degree I felt like a different person to the person who existed in 2000. I always felt haunted really.
Two years (2005) the seroxat seemed to stop working and no augmenting agent seemed to work.
I'm now trying Nardil (I had some left over from before) and although there is no anxiety, I feel wierd I have to say. This is bearable but I feel sort of morbid and morose.
I sometimes wish I had of died five years ago because at least I would have died ignorant of the fact that I was capable of feeling so horrible, so empty, so trapped, so scared and for no apparent reason. It's like I've been given glimpses of a hell I didn't know existed.
I'm not expecting a response to this just wanted to ramble.
I've also gone from being a fairly sensible pragmatic, cautious person to a desperate sounding and feeling person who will try practically any medication in an attempt to find relief.I just want somebody to transport me back in time and wipe out the last five years and let me carry on in my ignorance.
Sorry just wanted to ramble, not expecting a response.
Denise
Posted by Phillipa on January 3, 2007, at 14:49:03
In reply to I lost myself, posted by deniseuk190466 on January 3, 2007, at 13:08:29
I know the feeling as when I was 24 panic attacks and benzo valium got rid of them and I felt pretty normal for over 20 years. Now nothing works. So I empathize with you. Love Phillipa
Posted by bassman on January 3, 2007, at 17:38:45
In reply to I lost myself, posted by deniseuk190466 on January 3, 2007, at 13:08:29
Life becomes a 24 hour a day nightmare. I know what you mean..maybe you can hope to getting back to feeling better in awhile. I'm sorry you are hurting. Friends, meds, therapy are all we have at times like this (oh! And booze, exercise, meditation, etc. :>})
Please take care,
bassman
Posted by UgottaHaveHope on January 3, 2007, at 18:06:30
In reply to Re: I lost myself, posted by bassman on January 3, 2007, at 17:38:45
How did you respond to the Nardil?
Posted by saturn on January 3, 2007, at 21:05:15
In reply to I lost myself, posted by deniseuk190466 on January 3, 2007, at 13:08:29
Posted by med_empowered on January 4, 2007, at 0:15:32
In reply to Denise Q, posted by UgottaHaveHope on January 3, 2007, at 18:06:30
I can empathize...I wasn't on meds for as long as you were, but I was on a lot at a time, sometimes (up to 7) with a variety of psychiatric diagnoses. I'm med-free now, and I think that although its tough, I'm doing pretty well.
I think you should just try to keep your head up. You might find a drug that helps, but more important is finding something within yourself that will help propel you onwards, to move above and beyond all this.
Good luck.
Posted by med_empowered on January 4, 2007, at 2:33:31
In reply to Re: Denise Q, posted by med_empowered on January 4, 2007, at 0:15:32
I guess what I'm trying to say is that all is not lost. Think of the saying: where there's life, there's hope. Seriously--dire as your situation may seem right now, you can find your way out of it. I noticed in your last post that you are upset (and rightly so) b/c of your treatment at the hands of a callous shrink who thinks you are "unhappy" but not "depressed". I think the best thing you can do with his opinion is use it to your advantage. So..you're unhappy. This means you don't have a disease. This means that, while meds may help you, you don't necessarily *need* meds to keep going.
I read somewhere once that the point of (good) therapy was to make the client realize that there really wasn't a disease, after all. The idea, I guess, is that you should come to a point where you drop illusions about "diseases" and "disorders" and decide to have a conversation about improving your life. I think in his own way your old psychiatrist did you a favor. Now that you have been yanked out of the "diseased" category, you can have an intense, meaningful, in-depth conversation (with yourself, your friends, family, a therapist, people here at psycho-babble) about how to improve your life.
Good luck.
Posted by SLS on January 4, 2007, at 7:20:49
In reply to I lost myself, posted by deniseuk190466 on January 3, 2007, at 13:08:29
Your waking up at 4:00am has been a traditional prognosticator that TCAs had a good chance of working.
> I'm now trying Nardil (I had some left over from before) and although there is no anxiety, I feel wierd I have to say. This is bearable but I feel sort of morbid and morose.
Sometimes, weird is good early in treatment. Of course, morbid and morose are not the kinds of things one would hope for.
I have always wondered how well augmenting Nardil with either Provigil or amisulpride would work.
If you are experimenting, under no circumstances should you combine Nardil with an SSRI, Effexor, Cymbalta, or Anafranil. Serotonin syndrome with these drugs is almost guaranteed.
- Scott
Posted by Quintal on January 4, 2007, at 7:51:48
In reply to Re: I lost myself » deniseuk190466, posted by SLS on January 4, 2007, at 7:20:49
>I have always wondered how well augmenting Nardil with either Provigil or amisulpride would work.
I have too. Is Nardil thought to be more dopaminergic than Parnate? The patient information leaflet that comes with my generic tranylcypromine says it acts on both serotonin and noradrenaline. There's no mention of dopamine but I presume being an MAOI it has some effect on the dopamine system?
I asked my pdoc if we could augment Parnate with amisulpride after he refused to raise the dose above 30mg. He refused on the grounds that it would be too stimulating, but I think that could be an advantage with Nardil?
Q
Posted by SLS on January 4, 2007, at 8:20:47
In reply to I lost myself, posted by deniseuk190466 on January 3, 2007, at 13:08:29
Just a postscript.
By now, I'm sure you are confident in what you are suffering from. From your descriptions, I have come to the same conclusion as you have.
I believe that biological mood disorders exist and that sufferers from these disorders should be treated as if they have dysfunctional brains, regardless of how they came to be that way or how they come to function normally again.
I think it is sabotage to tell someone with a brain disorder that no such disorder really exists. We are well beyond this. In my case, I know what can and can't happen. Do you believe this to be true of you as well? Keep an open mind, but remain vigilant in reinforcing what you have come to know about your illness using historical observation and study of medicine.
I believe it is important to attack psychosocial issues with psychotherapy where appropriate. Even where no psychosocial stresses were exigent and no emotional triggers evident to precipitate a depression, the depression itself produces maladaptive psychological changes. Psychotherapy can optimize one's chances of recovering with greater stability from illness, even when biological treatments are absolutely necessary. Part of this does involve fostering a positive attitude and discouraging a negative one as much as is possible during a depressive episode, knowing in advance that the distorted thoughts produced by the depressive state make this most difficult.
In my case (and possibly yours), psychotherapy can help to produce coping tools and counter the negative distorted thinking produced by depression while I remain in the depressive state. However, this is not at all necessary if the right biological treatment comes along. I become magically functional and capable of processing issues on my own. I resolve the past and live in the present. I look forward to the possibilities and challenges of the future. I enjoy the experience of the moment. All of these things occur without effort. On the contrary, I am drawn to these things with great interest, motivation, and energy. Self-improvement is automatic. Life is fun. Life is worth it.
Let people convince themselves that their depressions are not biological disorders. Indeed, many are not. Proper diagnosis is important to choose proper treatment. Most people with properly diagnosed Major Depressive Disorder seem to do well with a biological intervention. It is unfortunate that discovering which treatment is right for each individual patient is still largely trial and error. A seasoned clinician can make better guesses than someone without experience, although extensive reading can produce insights as well. I don't think people with an exclusively psychogenic depression do well with antidepressants. However, there are plenty of people with biogenic depressions who have not yet found an effective treatment. How do you tell the difference between people, then? Proper diagnosis. Belief that a difference exists at all. I believe.
There is much anti-psychiatry sentiment to wade through here. I hope you don't get stuck in the mud.
http://sl.schofield3.home.att.net/medicine/nimh_depression_research.html
Psychotherapy might help you find important aspects of yourself again despite the persistence of the depressive state.
- Scott
Posted by SLS on January 4, 2007, at 9:00:33
In reply to Re: I lost myself » SLS, posted by Quintal on January 4, 2007, at 7:51:48
Hi Quintal.
> > I have always wondered how well augmenting Nardil with either Provigil or amisulpride would work.
> I have too. Is Nardil thought to be more dopaminergic than Parnate?Tough question. I have never seen anything written that states with confidence this to be true, but I wouldn't exclude the possibility. I find Nardil to be more of a "mood brightener" than Parnate with a greater increase in the experience of reward and enjoyment of activities. I happen to think that Nardil is a more potent MAO-A inhibitor than Parnate. I wouldn't discount the possibility that this is the result of either:
1. The localization of MAO inhibition different than Parnate.
2. An energizing or anhedonic property other than MAO inhibition.
3. A greater degree of MAO-A inhibition relative to Parnate, which would produce increases of dopamine in cortex and hippocampus.
> The patient information leaflet that comes with my generic tranylcypromine says it acts on both serotonin and noradrenaline.
I think that may be because dopamine was never considered by the pharmaceutical companies as important in the actions of antidepressant drugs. It is a bias in writing rather than a reflection of pharmacology.
> There's no mention of dopamine but I presume being an MAOI it has some effect on the dopamine system?
I'm pretty sure both Parnate and Nardil inhibit MAO-B enough to produce an increase in the concentration of dopamine in the LOCALITIES that the drug penetrates and the enzyme acts. MAO-A also acts to deaminate dopamine in various regions where MAO-B doesn't exist.
> I asked my pdoc if we could augment Parnate with amisulpride after he refused to raise the dose above 30mg.
30mg? <sigh of frustration>
I guess I don't need to tell you that the dosage effective range is more like 40-80mg. It doesn't sound like there is too much that will pursuade your doctor to change his mind. Have you brought in any literature for him to look at?
http://sl.schofield3.home.att.net/medicine/mao_inhibitors_option_trd.html
> He refused on the grounds that it would be too stimulating, but I think that could be an advantage with Nardil?
My guess is that it would not produce overstimulation beyond the first few days, if at all.
- Scott
Posted by deniseuk190466 on January 5, 2007, at 11:32:21
In reply to more..., posted by med_empowered on January 4, 2007, at 2:33:31
Med-Empowered,
Thanks for your response and interest and I do appreciate your comments.
I know that I am fortunate in that I can work, function and to some degree "fake it", for two years I struggled with a demanding job at IBM, having awful anxiety attacks and suicidal thoughts whilst trying to facilitate conference calls and manage projects. Sometimes doing this did overide the anxiety and suicidal thoughts but I'd get home feeling weak and completely lifeless and just lie on the bed. Weekends would bring me right down and I'd try going on little holidays for weekend breaks but I'd just feel worse and my boyfriend at the time would get pissed off with me because I couldn't even bear to sit in a restaurant and eat a meal for a lengthy period without wanting to rush off and go for a long walk.
I do know that there is a cycle and sometimes my thoughts can get way out of hand but I also feel/hope that there is something biological going on that can be conrolled.
This Professor believes (implicitly it seems) that you are in total control of your thoughts and your thoughts control your feelings. But can't it be the other way around too. Afterall if you feel crap, sick,tired, weak, anxious most of the time isn't that going to affect your thoughts? If you spend the day longing for bed and trying to keep yourself out of it then isn't that going to make you feel bad about yourself? Also, this business about negative thoughts, well what's the difference between a negative thought and a realistic one.
I know sometimes there are things that do divert my attention from myself and do help. During Willow View I found that sometimes attending the group therapies helped because I was having to focus on what the Nurse was saying and what other people were saying and because I was able to contribute. But this was in the same way as work helped, having conference calls helped. By the same token though I dreaded Christmas, could barely bring myself to buy Christmas presents (unlike me) and was just getting through the days. When one of the nurses asked me if I was ready for christmas, I felt like the two of us were on different planets.
I have also spent last year doing voluntary work at Cancer Research Shop, whilst on Seroxat, keeping busy seemed to help. But after coming off Seroxat and then being off it for a while and then switching to Mirtazapine, even being there, being busy didn't help.
I don't know what I am expected to do in order to lead a forefilling life. There is always this suggestion when you are depressed that there is something you should be doing that you are just not doing in order to feel like life is worth living. Pre 2001, I was fairly content, I had a good job which I enjoyed, admittedly my relationship with my boyfriend was getting a bit boring but nothing really bad was going on. I didn't have to suddenly turn myself into Florence Nightingale in order to feel ok about myself and my life and I'm not sure why I should need to now.
A well meaning neighbour suggested to me that I should get a job or do some kind of work with Cancer Patients (people who are worse off than I) but the thing is, when I'm at my worse, I hate to say this, I sort of envy people who have a life threatening condition. When I hear how so and so died, I feel envious. Is that distorted or what? A friend of a friend hung herself recently and rather than thinking "God how awful" I kept thinking maybe she did the right thing, she's at peace now and I kept thinking I wish I had the courage to do it myself. Sometimes I get into a real state because I really just want to kill myself and end it but then when I start to make plans I no I can't do it and then I get even more worked up so I end up wishing I could just be in an accident and then all this would be over and done with.
I have no reason to be unhappy. I have no reason to feel sick, anxious, empty and lifeless.
I have to say one thing, I am taking Nardil right now and at the moment I don't feel anxious, infact the Nardil has taken that away but the above holds true of how I feel without medication.
I was depression free on medication for years in the 1990s and then came off it because I felt I should try and do it alone. I then came off it and was ok for three years and it felt good during that time to feel in control of my moods and my life without medication. Infact now and again I'd have bad dreams that I was back on it again. I also thought that that time med free and depression free that the reason I wasn't depressed was because I was somehow living my life better, I had the good permanent job, had a boyfriend, was reliable and hardworking etc ect. That somehow I was responsible for not being depressed, that I was in control. But all of that came to an end in 2001.
I'm the sort of person who hates having to take an aspirin even when I'm in really bad pain, infact I rarely take pain killers but I expect if my pain was daily and unremitting then I would succumb to taking pain killers. If the depression I have suffered just came on in bouts like two or three days a week and then went away, then I would get through those days knowing that the other days would be better but when it's day in day out I just can't do it.
I know you say you are medication free but when you took it did it work for you? How do you cope with your depression being medication free? and do you have any tips on how I could somehow lead a forefilling, life, one that provides me with some satisfaction without being on medication? Do you exist on a day to day basis, without planning for holidays etc or looking forward to anything, without being able to enjoy music or a film and is that sufficient for you?
I do get confused though about what's wrong with me and I do blame everything on my depression, for instance, I went for a temporary job the other day. I didn't get it because I hadn't bothered to look at the job description. I hadn't bothered because I wasn't interested and it was just an admin job covering somebody who was off sick. I ususually do make myself thoroughly research the company and the job but in this case I didn't. I got to the interview and I felt pretty much not bothered about the job, although I tried my best at the interview. But I hate the fact sometimes that deep down inside I just don't really care enough sometimes to be even bothered about rejection. I get passed caring and then I hate myself for not caring anymore.
Denise
This is the end of the thread.
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