![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by dapper on January 7, 2009, at 0:52:35
Being on nefazadone started to make me feel better gradually. Finally felt like I was improving. Be lying if I didn't say that I feel I am heading downwards again. Wake up feeling the weight of depression and suicide is constantly on mind. Half is situational, as I just got laid off and have pressure on to get a new job. Plus, hearing that my ex is dating someone regularly now is putting this weird painful weight in my mind.
Do I trudge forward and work through my probs, without messing with meds, or should I conclude that my meds are gonna be ineffective and I should pursue something else? I feel like the depression is becoming a snowball, growing in size as it rolls. Does everyone feel like this when things are not great, or is there something fundamentally wrong with my brain? I'm living a pained existence once again.Currently:
400mg nefazadone
50mg lamictal
25mg seroquel to counteract insomnia
Posted by SLS on January 7, 2009, at 7:05:21
In reply to Was improving, now degrading?, posted by dapper on January 7, 2009, at 0:52:35
> Currently:
> 400mg nefazadone
> 50mg lamictal
> 25mg seroquel to counteract insomniaThe first thing I noticed is that your dosage of Lamictal is rather low. Numerous studies and my personal experience with this drug is that 200mg is optimal. As long as you have been taking 50mg for at least 2 weeks, you can move right up to 100mg. Why was nefazodone chosen? What antidepressants have you tried? What dosages? How long?
Is morning the worst time for you?
Do you have trouble sleeping after 3:00am?
Do you feel as if your movements are slowed down?
Do you speak noticeably slowly?
Have you lost weight?
Do you dwell on or have intrusive negative or melancholic thoughts.
* I doubt you will be condemned to live in a depressive state for years on end. There are simply too many effective drugs and combinations of drugs not to remain optimistic.
- Scott
Posted by Phillipa on January 7, 2009, at 11:03:09
In reply to Re: Was improving, now degrading? » dapper, posted by SLS on January 7, 2009, at 7:05:21
Dapper so sorry to hear you were laid off and your ex is dating another. I wonder have you also talked to a therapist about the situational problems leading to increased depression? Any imput fron your pdoc? Phillipa
Posted by dapper on January 7, 2009, at 18:22:00
In reply to Re: Was improving, now degrading? » dapper, posted by SLS on January 7, 2009, at 7:05:21
Hey Scott, thanks for the detailed response. I will try and address each question.
Lamictal dose I am keeping low because when I was on 200mg with effexor, I started to get really bad itching and hives on my thighs. Not 100% sure it was solely the lamictal, but the loss of sleep I had at that period and the annoyance of that itch has kept me at a low dose.
Nefazadone chosen at my request. Mainly because I have tried many other drugs before, and I wanted to try something that had a slightly diff. action, plus the sexual side effects became too much for me.
Can't call it the morning cause I wake up between 12-1p.m. these days, but I do feel the worst upon waking, the best late at night. I usually take my seroquel around 10pm, then go to sleep between 12-1a.m.
Movements are not really slowed down, just takes more effort to do everything, cause I really am just not interested.
Speaking patterns are about the same. I am still a good conversationalist, and talk well. People prob think I'm a pretty content guy if they dont really know me. But underneath the mask is severe pain.
Weight loss is significant, appetite is in the cr*pp*r. I have a high metabolism as is, but I have to force myself to eat these days.
Depressive thoughts are with me all day, everyday. Part of it I'm sure is situational due to life factors, but I should be coping better. It can't be 'normal' to have this mindset day in and day out, cause half of the people alive today would end up killing themselves. Suicide is on my mind a lot, but I'm not gonna act on it. I contemplate it to the extent that I think about what I would write in my note, where I would do it, and how. I have even done research on the most effective ways. That also can't be normal.
Drugs I have tried:(with the doses I can remember)
Celexa
Zoloft
Wellbutrin 150mg/daily
Cymbalta
Effexor 225mg/daily (worked well but pooped out)
Lamictal 50mg/daily presently
Nefazadone 400/daily presently
Prozac
LexaproMaybe 1 or 2 more, but can't recall right now. Thinking about trying lithium. Maybe increase dose of lamictal again to see response. Thanks again for your insight, very much appreciated.
Posted by SLS on January 7, 2009, at 18:44:00
In reply to Re: Was improving, now degrading?))SLS, posted by dapper on January 7, 2009, at 18:22:00
Hi.
Based upon the answers to my questions, I would say that you might be a tricyclic responder. I don't see any of these TCA type drugs on your list. The other drug that comes to mind is Effexor. It does not surprise me that it was one of the better drugs for you. Tricyclics don't poop-out as often as the SRIs.
- Scott
Posted by dapper on January 7, 2009, at 19:16:10
In reply to Re: Was improving, now degrading?))SLS, posted by SLS on January 7, 2009, at 18:44:00
Last time I brought up the idea of a tri to my doc, he shot it down, saying they are loaded with side effects. Your thoughts/experiences? What are the most common SE of them?
Posted by dapper on January 8, 2009, at 21:44:35
In reply to Re: Was improving, now degrading?))SLS, posted by dapper on January 7, 2009, at 19:16:10
SLS, your experiences with tri's? I have entered into that snowball effect. My depressive thoughts are building and I'm getting more and more uncomfortable. Wonder how long I can stay like this before something gives. Great to be back in this mental place.
Posted by SLS on January 9, 2009, at 8:08:25
In reply to Re: Was improving, now degrading?))SLS, posted by dapper on January 8, 2009, at 21:44:35
> SLS, your experiences with tri's? I have entered into that snowball effect. My depressive thoughts are building and I'm getting more and more uncomfortable. Wonder how long I can stay like this before something gives. Great to be back in this mental place.
It is a blessing that you understand so well the interaction (snowball effect) of depression with depression: with depression making depression worse making depression, making depression worse... etc. This insight might help you stay functional longer and reduce the painful descent into darkness.
With tricyclics, it is usually better to choose one of the secondary amines first, as they have milder side effects than the tertiaries. However, I wouldn't leave TCAs behind until you try imipramine at some point it is more potent than the others. In fact, just about the best drug for OCD is clomipramine (Anafranil) - imipramine with a chlorine atom attached. The two secondary amines are desipramine (Norpramin) and nortriptyline (Pamelor). They do not produce the magnitude of anticholinergic side effects that the others do. I am not sure which of the TCAs to try first. Nortriptyline is generally less activating than desipramine and is somewhat sedating, especially at first. It is a good drug, and I have had good luck with it. I had better luck with desipramine when it was combined with Parnate. It brought me to complete remission. It is a long story, but I no longer respond well to these two drugs without having to add a third and fourth.
It is a gamble to decide which drug to choose first. Some people do not respond to desipramine at all, who later go on to respond wonderfully to nortriptyline. The opposite is also true. These two drugs are each from a different series of compounds, so they are both worth trying. Unlike desipramine, which is a very selective NE reuptake inhibitor, nortriptyline adds some mild 5-HT reuptake inibition, 5-HT2a antagonism, and NE alpha-2 antagonism. I guess I just convinced myself that nortriptyline should be the first choice. You know, of course, that I don't have a crystal ball, and can give no guarantees. I think I would choose imipramine if nortriptyline doesn't work. It will give you a better chance of getting well than desipramine. If it works, you can then try to switch over to desipramine to mitigate the side effects. Actually, imipramine is broken down into desipramine (through desmethylation) in the body. Once equilibrium is established, there is usually significantly more desipramine flowing through your arteries than imipramine.
1. Nortriptyline
2. ImipramineOne step at a time. Depending on your reactions to these two drugs, it may or may not indicate investigating the other tricyclics.
There are lots of ideas floating around as to how to augment TCA and other antidepressants if monotherapy proves inadequate.
- Scott
Posted by JadeKelly on January 9, 2009, at 19:22:50
In reply to Was improving, now degrading?, posted by dapper on January 7, 2009, at 0:52:35
Hi Dapper,
I'm sorry I cant offer an opinion regarding your medications, other than to say if they are no longer doing their job you should definately check with your PDoc about possible change to something that WILL work for you again.
As for the depression, thats exactly how it happened for me. I had many things in my life that went very wrong all at once. And I went into a deep depression. I think we are genetically predisposed and with the right number of triggers we end up with a hating life biological depression. This is my first one, I honestly didn't know I was capable of feeling this bad. Is that like yours? I let mine go for too long so now I'm having to be really aggressive (and patient while I'm feeling terrible) and I know I will beat this and so will you. Please keep posting about how you are doing and don't give up. Things WILL get better.
~Jade
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.