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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 greywolf on May 14, 2009, at 1:46:32
This will be a long one.
I was recently hospitalized for severe depression and self-injury. I'm now home and back to work, but the depression is not markedly reduced. As I mentioned above, I have a VNS implant, have done ECT recently, and take Parnate 60mg/day, Cytomex 50mcg/day, Xanax 4.5mg/day, as well as Lunesta and Ambien. I've had some good days, but most of them are dismal.
The problem I face is that after all of these years of treatment, my med options are really limited for depression and OCD. I'll try to list the meds I've taken at a therapeutic level without benefit:
Paxil
Prozac
Serzone
Effexor
Lexapro
Celexa
Wellbutrin
Zoloft
Luvox
Remeron
Tofranil
Clomipramine
Imipramine
Symbyax
Seroquel
Lamictal
Depakote
Lithium
Risperdal
Abilify
Zyprexa
Xanax
Klonopin
Atavan
Valium
Cytomex
Nardil
Ensam
Parnate
Trazadone
DoxepinMany of these were multiple courses. I am sure that there are a few I forgot. I didn't add in my migraine injections and asthma meds.
There are some pretty bright people on this Board, and I'd really appreciate it if anyone could take a few moments to either suggest something that's compatible with my current regime that will address the OCD, or suggest a whole new treatment plan altogether. Right now, I'm just confused and tired and hating life.
Thanks.
Greywolf
Posted by Alexanderfromdenmark on May 14, 2009, at 6:49:09
In reply to Any suggestions?, posted by greywolf on May 14, 2009, at 1:46:32
> This will be a long one.
>
> I was recently hospitalized for severe depression and self-injury. I'm now home and back to work, but the depression is not markedly reduced. As I mentioned above, I have a VNS implant, have done ECT recently, and take Parnate 60mg/day, Cytomex 50mcg/day, Xanax 4.5mg/day, as well as Lunesta and Ambien. I've had some good days, but most of them are dismal.
>
> The problem I face is that after all of these years of treatment, my med options are really limited for depression and OCD. I'll try to list the meds I've taken at a therapeutic level without benefit:
>
> Paxil
> Prozac
> Serzone
> Effexor
> Lexapro
> Celexa
> Wellbutrin
> Zoloft
> Luvox
> Remeron
> Tofranil
> Clomipramine
> Imipramine
> Symbyax
> Seroquel
> Lamictal
> Depakote
> Lithium
> Risperdal
> Abilify
> Zyprexa
> Xanax
> Klonopin
> Atavan
> Valium
> Cytomex
> Nardil
> Ensam
> Parnate
> Trazadone
> Doxepin
>
> Many of these were multiple courses. I am sure that there are a few I forgot. I didn't add in my migraine injections and asthma meds.
>
> There are some pretty bright people on this Board, and I'd really appreciate it if anyone could take a few moments to either suggest something that's compatible with my current regime that will address the OCD, or suggest a whole new treatment plan altogether. Right now, I'm just confused and tired and hating life.
>
> Thanks.
>
> Greywolf
Wow that's a lot of meds. I'm a med amateur so I can't really offer a lot of perspectives, but I've read that putting testosterone into optimal ranges have been succesfull in treatment resistant depression in males.
Posted by SLS on May 14, 2009, at 6:51:34
In reply to Any suggestions?, posted by greywolf on May 14, 2009, at 1:46:32
I am not so much bright as I am experienced.
I have consistenly had at least partial success combining a MAOI with a tricyclic. I am currently interested in trying to extrapolate my success with Lamictal to other anti-glutamatergic drugs. My most recent trial of memantine, a GLU NMDA receptor non-competitive antagonist, seems to be a failure. The NIMH found memantine to be ineffective as monotherapy. However, that doesn't mean very much to me when it is my position that some drugs are only effective when they are used as adjuncts to others. Memantine does seem to be effective in treating OCD, even when given as monotherapy.
My current regime:Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
What is the self-injury about? Is it something like "cutting", or are we talking about suicide? For a cutting type thing, sometimes naltrexone helps. Suboxone would be an interesting drug for you to try. Also, Trileptal is good for treating impulsive or aggressive behavior.Quick strategy: Come up with a list of drugs that you have had even the briefest of partial responses to and begin to combine them by selecting from different categories.
A friend of mine started out with Wellbutrin and gleaned a partial improvement in energy. She switched over to Effexor and experienced an improvement in interest and motivation, but not energy. She was still too anergic to function. It was her idea to combine the two drugs as they seemed to improve complementarily her symptom cluster. She has done well for the most part. She feels better still for having switched from Effexor to Lexapro and adding Geodon.
Her current regime:Wellbutrin XL 300mg
Lexapro 40mg
Geodon 80mgShe believes that she has attained remission.
Perhaps you could show us a list of only those drugs that produced an improvement in symptomology, even if they were otherwise intolerable.
- Scott
Posted by linkadge on May 14, 2009, at 8:23:49
In reply to Any suggestions?, posted by greywolf on May 14, 2009, at 1:46:32
I'd say lower the parnate dose, add some mirapex, folate and EPA.
Linkadge
Posted by greywolf on May 14, 2009, at 8:57:46
In reply to Re: Any suggestions?, posted by linkadge on May 14, 2009, at 8:23:49
> I'd say lower the parnate dose, add some mirapex, folate and EPA.
>
> LinkadgeLinkadge, if you don't mind me asking, why Mirapex? I didn't know they were using it off-label for depression.
Greywolf
Posted by Phillipa on May 14, 2009, at 12:16:26
In reply to Re: Any suggestions?, posted by greywolf on May 14, 2009, at 8:57:46
Greywolf I know you know I can't help with the meds but I can offer my support. Love Phillipa
Posted by Sigismund on May 14, 2009, at 16:11:33
In reply to Re: Any suggestions?, posted by greywolf on May 14, 2009, at 8:57:46
Have people been talking about memantine for OCD?
Anyway, I noticed it was not in your long list.
Posted by Sigismund on May 14, 2009, at 16:18:30
In reply to Re: Any suggestions?, posted by Alexanderfromdenmark on May 14, 2009, at 6:49:09
Getting testosterone right is not such a bad idea.
It helped me somewhat.
Posted by greywolf on May 14, 2009, at 19:49:34
In reply to Re: Any suggestions? » greywolf, posted by Sigismund on May 14, 2009, at 16:11:33
Thanks for the suggestion. I'm going to take it up with my doc next week.
Greywolf
Posted by Sigismund on May 14, 2009, at 21:27:19
In reply to Any suggestions?, posted by greywolf on May 14, 2009, at 1:46:32
Then there is the idea about n-acetyl cysteine and OCD.
What is OCD anyway?
Some kind of anxiety syndrome where you feel like you are being rung out like a dishrag?If so, I empathise.
Posted by softheprairie on May 15, 2009, at 3:25:03
In reply to Any suggestions?, posted by greywolf on May 14, 2009, at 1:46:32
Wow; you really deserve a metal for still hanging on to life.
On the OCD, aside from the ones already mentioned, there is some evidence for riluzole (its current approval is for ALS/Lou Gerig's disease). There's been a little bit of talk on psychobabble about it. I learned of it from a publication in which the OCFoundation mentioned it being researched. Also, even though it's considered a last-ditch effort, sometimes stimulants can help OCD (and depression).On the depression side, with so many not helping, any other ones face poor odds. Even with that said, I didn't see Marplan, desipramine, or perphenazine on the list (the latter two are in my coctail).
I hope you can continue on until things get better. :(
Posted by greywolf on May 15, 2009, at 6:38:49
In reply to Re: Any suggestions? » greywolf, posted by softheprairie on May 15, 2009, at 3:25:03
> Wow; you really deserve a metal for still hanging on to life.
> On the OCD, aside from the ones already mentioned, there is some evidence for riluzole (its current approval is for ALS/Lou Gerig's disease). There's been a little bit of talk on psychobabble about it. I learned of it from a publication in which the OCFoundation mentioned it being researched. Also, even though it's considered a last-ditch effort, sometimes stimulants can help OCD (and depression).
>
> On the depression side, with so many not helping, any other ones face poor odds. Even with that said, I didn't see Marplan, desipramine, or perphenazine on the list (the latter two are in my coctail).
>
> I hope you can continue on until things get better. :(
>Thanks, softtheprairie. Unfortunately, my doctor won't prescribe a stimulant because I'm bipolar with a history of manic episodes.
I've been on desipramine, but not Marplan or perphenazine. So you've given me some research to do :)
Thanks again.
Greywolf
Posted by Amelia_in_StPaul on May 18, 2009, at 16:04:23
In reply to Any suggestions?, posted by greywolf on May 14, 2009, at 1:46:32
but I want you to know that you are such a strong and courageous person for doing the med-go-round like no one I've known. I am sorry you've been through so much. ~Amelia
Posted by desolationrower on May 19, 2009, at 0:04:59
In reply to Re: Any suggestions? » greywolf, posted by SLS on May 14, 2009, at 6:51:34
just agree with scott, should write lists of medicine sorted by how they affected you
otherwise just shooting in the dark
-d/r
This is the end of the thread.
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