![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Walfredo on December 24, 2009, at 4:03:22
Hi everyone,
Let me just say first that I have been a lurker here for a few months now after discovering a thread while googling "atypical depression". After my initial discovery, I have come back time and again to utilize the search forums function any time I have a question about anything depression/mental health or medication related, and I generally find I learn more from reading whatever comes up in the search results from discussions here than I could anywhere else on the web. I have to say, I am extremely impressed with both the knowledge and compassion expressed in this forum. It truly is an amazing resource; I only wish I had found this place sooner.
So, a brief personal background at the risk of turning this into an essay....
I am in my mid-twenties and have been struggling with "atypical depression" since at least my early to mid teens if not earlier (I use quotation marks because atypical depression is sort of my working diagnosis though I am not 100% certain of the diagnosis). I first sought help my first year in college when I was 18 but I was symptomatic for years before I realized that not everyone was "having as hard a time" as me. Anxiety was a major problem for me then especially pertaining to social situations and I was avoidant of social situations when I "felt bad". Nowadays, after aggressively going after my anxiety and largely conquering it by enacting some lifestyle changes along with CT (I now believe depression was my issue all along though anxiety largely brought me to see a pdoc), I would characterize my main symptoms as problems with energy/fatigue, concentration, memory, slowed thinking, and lack of real enjoyment in things I should enjoy. I am also very prone to oversleeping (hypersomnia is the the term I think) and overeating, and "mood reactivity" was a phenomenon I described to the first psychiatrist I ever saw but had a hard time describing the phenomenon, not knowing if such a thing even made sense in the context of psychology. Ironically, I never had even discussed "atypical depression" specifically with any of my doctors but stumbled across a link defining it while reading about MAOI's on wikipedia and it sounded just like me! I digress.
Up til now, I have tried virtually every SSRI/SNRI on the market (except Pristiq) with little to no positive effect EXCEPT FOR PAXIL CR. Paxil CR was like the fourth antidepressant I tried and within a few days of bumping up the dose to 25 mg (after several weeks at 12.5), it was like someone flipped a switch. I had a amazing sustainable improvement in my mood (and all major symptoms) way before the usual 2 week allotted time (after a couple of days I believe). So, I had a great run on Paxil CR (totally satisfied and content) for about a year until it "pooped out" at which point I decided to try to go alternative/antidepressant free for about 18 months but again became frustrated with lack of progress and starting going to see the psychiatrist again.
So most recently, I decided to try Paxil CR again and even went to 37.5 mgs to see if a dose increase might help. It didn't - though I did get like 1 excellent day when I went back down to 25 mg from the 37.5 (more on this in a bit). After too long of a second try with the Paxil CR, I researched MAOI's because a previous doctor had suggested Emsam to me. Well, due to the cost of Emsam, I ended up trying Nardil instead and only made it up to 60 mg before the side effects (namely insomnia and anorgasmia) because unbearable. At this point even though I wasn't at a max dose, I decided to cut bait and began seeing a new doctor who I discussed this with. She and I agreed there were other unexplored options with potentially more manageable side effects and we could try MAOI's down the road if need be.
So...(are you still reading? If so, hats off to you good people), I got off the Nardil, did my washout period, and she has me currently trying Abilify. I did two weeks at 2.5 mg and have been on 5 mg for about a week. No improvement and I'm starting to think I may feel a bit subtly worse (sometimes it's hard to tell with all the withdrawals and switching of meds) but definitely no improvement.
I am scheduled to see here the first week of the new year and assuming everything else remains the same, I am wondering where to go next. I read on here that sometimes Remeron is used for "Paxil poop-out" and interestingly my new doctor asked me specifically if I had tried it so that may be an option. I am also very intrigued by the supplement SAM-e and really want to give it a try as well (anyone know a good online source to buy it at reasonable cost and good quality???).
A few other interesting tidbits are:
Sleep deprivation totally helps my depression almost to the point of 100% remission or close to it. Have felt better on no sleep for as long as I can remember. Even when I couldn't sleep but 3 hrs per night on Nardil, I began to feel good although mixed in with the zombie-ness of being that sleep deprived. I thought the Nardil might be working but it turns out it was just the lack of sleep because the insomnia improved slightly, I slept more, and the mood improvement went away).
I already mentioned Paxil CR was great to me. Very early response upon going up to the 25 mg (which I have now read could possibly be indicative of bipolar II which I would have never even considered for myself until reading more about how subtle it can be on here. This is partly why I am hesitant to say I am definitely atypically depressed though it seems to be the most consistent with my history and symptoms.)
Finally, another phenomenon I have CONSISTENTLY experienced is that when I come off SSRI's, I feel better for like a day or two. Like consistently with almost all that I have tried from Zoloft to Prozac to Lexapro (and maybe even Cymbalta which I know is an SNRI). I have tried to find similar testaments on here but don't know what search terms to use for this phenomenon. It happened again when I went down from 37.5 mg to 25 mg in my second trial of Paxil CR after the initial "poop-out". A few days after the decrease, one day I woke up feeling good, wanting to go out and do stuff. Not manic (I dont think) or anything euphoric but feeling like I felt when I was a kid. Crazy. Just not depressed. And this has happened consistently across all or most of the SSRI's. Can anyone shed any light on this at all???
Well, that's all I have for now. I will check back in a day or so and see if anyone has responded. Any feedback or suggestions are welcome. I am determined to figure out something that works because I have had glimpses of how good life can be.
Best of luck to all of you in your quests to be well and a happy (as possible) holidays to you all.
Sincerely,
Alex
Posted by ace on December 24, 2009, at 6:22:42
In reply to Help w/ atypical depression? (my first post here), posted by Walfredo on December 24, 2009, at 4:03:22
> Hi everyone,
Hello and welcome here!
> Let me just say first that I have been a lurker here for a few months now after discovering a thread while googling "atypical depression". After my initial discovery, I have come back time and again to utilize the search forums function any time I have a question about anything depression/mental health or medication related, and I generally find I learn more from reading whatever comes up in the search results from discussions here than I could anywhere else on the web. I have to say, I am extremely impressed with both the knowledge and compassion expressed in this forum. It truly is an amazing resource; I only wish I had found this place sooner.I agree. This is the best mental health public forum on the web, I feel.
> So, a brief personal background at the risk of turning this into an essay....
>
> I am in my mid-twenties and have been struggling with "atypical depression" since at least my early to mid teens if not earlier (I use quotation marks because atypical depression is sort of my working diagnosis though I am not 100% certain of the diagnosis).Personally, I would not get too wound up in all these labels. Ultimately they do not mean a great deal, especially when it comes to pharcological treatment. They can restrict possibly helpful treatments when used too stringently.
That being said, we do need them to a certain extent.I would characterize my main symptoms as problems with energy/fatigue, concentration, memory, slowed thinking, and lack of real enjoyment in things I should enjoy. I am also very prone to oversleeping (hypersomnia is the the term I think) and overeating, and "mood reactivity" was a phenomenon I described to the first psychiatrist I ever saw but had a hard time describing the phenomenon, not knowing if such a thing even made sense in the context of psychology. Ironically, I never had even discussed "atypical depression" specifically with any of my doctors but stumbled across a link defining it while reading about MAOI's on wikipedia and it sounded just like me! I digress.
> Up til now, I have tried virtually every SSRI/SNRI on the market (except Pristiq) with little to no positive effect EXCEPT FOR PAXIL CR. Paxil CR was like the fourth antidepressant I tried and within a few days of bumping up the dose to 25 mg (after several weeks at 12.5), it was like someone flipped a switch. I had a amazing sustainable improvement in my mood (and all major symptoms) way before the usual 2 week allotted time (after a couple of days I believe). So, I had a great run on Paxil CR (totally satisfied and content) for about a year until it "pooped out" at which point I decided to try to go alternative/antidepressant free for about 18 months but again became frustrated with lack of progress and starting going to see the psychiatrist again.I have not much faith in the SSRI's, I am glad Paxil worked for you but. Did you experience any major withdrawal problems?
> So most recently, I decided to try Paxil CR again and even went to 37.5 mgs to see if a dose increase might help. It didn't - though I did get like 1 excellent day when I went back down to 25 mg from the 37.5 (more on this in a bit). After too long of a second try with the Paxil CR, I researched MAOI's because a previous doctor had suggested Emsam to me. Well, due to the cost of Emsam, I ended up trying Nardil instead and only made it up to 60 mg before the side effects (namely insomnia and anorgasmia) because unbearable.OK, I am a HUGE fan of Nardil.
How quickly was the dose raised to 60mg?
In what manner were you taking the drug (i.e. at what time of the day?, split doses?)
Did you try any other medications to offset the stated s/effects, or reduce the dose until they abated?
At this point even though I wasn't at a max dose, I decided to cut bait and began seeing a new doctor who I discussed this with. She and I agreed there were other unexplored options with potentially more manageable side effects and we could try MAOI's down the road if need be.
>
> So...(are you still reading? If so, hats off to you good people), I got off the Nardil, did my washout period, and she has me currently trying Abilify.I certainly would not try this before Nardil!
Abilify is an antipsychotic, which, I feel, should be used after an MAOI trial.
The symptoms you described above....I feel Nardil or Parnate would be much better for treating these. Even give the TCA's a go before trying an atypical, I would think.I did two weeks at 2.5 mg and have been on 5 mg for about a week. No improvement and I'm starting to think I may feel a bit subtly worse (sometimes it's hard to tell with all the withdrawals and switching of meds) but definitely no improvement.
Are you feeling any increased feeling of agitation, anxiety?
More worse in terms of depression?
> I am scheduled to see here the first week of the new year and assuming everything else remains the same, I am wondering where to go next. I read on here that sometimes Remeron is used for "Paxil poop-out" and interestingly my new doctor asked me specifically if I had tried it so that may be an option.Remeron is not too bad I think. In terms of efficacy I would rate it over the SSRI's, on the whole. However, weight gain is quite common, and some other s/effects I do not see as much in the SSRI's.
You mention hypersomnia: this may be a problem with remeron, as sedation is a very common s/effect with this agent.
I am also very intrigued by the supplement SAM-e and really want to give it a try as well (anyone know a good online source to buy it at reasonable cost and good quality???).Not me...anyone else out their can help with this??!!
> A few other interesting tidbits are:
>
> Sleep deprivation totally helps my depression almost to the point of 100% remission or close to it.This is common. Only problem is, there is usually rebound depression from this....even if it takes a while to catch up to you.
What sort of length of deprivation have you endured?
Have felt better on no sleep for as long as I can remember. Even when I couldn't sleep but 3 hrs per night on Nardil, I began to feel good although mixed in with the zombie-ness of being that sleep deprived. I thought the Nardil might be working but it turns out it was just the lack of sleep because the insomnia improved slightly, I slept more, and the mood improvement went away).Nardil suppresses REM sleep...I think there are many more pertinent variables coming into play here.
I would need to know the answers to the questions I asked above with regards to Nardil.
> I already mentioned Paxil CR was great to me. Very early response upon going up to the 25 mg (which I have now read could possibly be indicative of bipolar II which I would have never even considered for myself until reading more about how subtle it can be on here. This is partly why I am hesitant to say I am definitely atypically depressed though it seems to be the most consistent with my history and symptoms.)
>
> Finally, another phenomenon I have CONSISTENTLY experienced is that when I come off SSRI's, I feel better for like a day or two. Like consistently with almost all that I have tried from Zoloft to Prozac to Lexapro (and maybe even Cymbalta which I know is an SNRI). I have tried to find similar testaments on here but don't know what search terms to use for this phenomenon. It happened again when I went down from 37.5 mg to 25 mg in my second trial of Paxil CR after the initial "poop-out". A few days after the decrease, one day I woke up feeling good, wanting to go out and do stuff. Not manic (I dont think) or anything euphoric but feeling like I felt when I was a kid. Crazy. Just not depressed. And this has happened consistently across all or most of the SSRI's. Can anyone shed any light on this at all???I have heard of this. Do you want a whole biochemical hypothesis on it?
> Well, that's all I have for now. I will check back in a day or so and see if anyone has responded. Any feedback or suggestions are welcome. I am determined to figure out something that works because I have had glimpses of how good life can be.
I really question the use of Abilify at this stage in your treatment.
It very well could produce great results in time (It may not too!), but i would advise certainly to give the MAOI's and TCA's a go.Then, if they didn't help, which would suprise me, I would then think about augmentaion (of the above) with other medications (of the same class, or of another).
However, I would advise to stick to monotherapy as much as possible.
> Best of luck to all of you in your quests to be well and a happy (as possible) holidays to you all.
>
> Sincerely,
> AlexHope this helps!
Ace:)
Posted by West on December 24, 2009, at 8:50:21
In reply to Re: Help w/ atypical depression? (my first post here) » Walfredo, posted by ace on December 24, 2009, at 6:22:42
'Finally, another phenomenon I have CONSISTENTLY experienced is that when I come off SSRI's, I feel better for like a day or two.'
All SSRIs are indirectly anticholinergic so you experienced cholinergic rebound, which feels good, (before you inevitably relapse into hellish depression).
Could be lessened REM sleep suppression making you feel better slept/more restored (like back in the day when you were young and unconflicted)
Posted by linkadge on December 24, 2009, at 11:09:06
In reply to Re: Help w/ atypical depression? (my first post here), posted by West on December 24, 2009, at 8:50:21
I assume you've tried wellbutrin? Desipramine might also be worth a try.
Posted by SLS on December 24, 2009, at 11:22:28
In reply to Re: Help w/ atypical depression? (my first post here), posted by West on December 24, 2009, at 8:50:21
> All SSRIs are indirectly anticholinergic
I didn't know that. How does that work?
- Scott
Posted by SLS on December 24, 2009, at 11:27:17
In reply to Re: Help w/ atypical depression? (my first post here), posted by linkadge on December 24, 2009, at 11:09:06
> I assume you've tried wellbutrin? Desipramine might also be worth a try.
A few doctors I know feel that there is a positive association between sleep deprivation response and Wellbutrin response.
- Scott
Posted by Phillipa on December 24, 2009, at 12:42:18
In reply to Re: Help w/ atypical depression? (my first post here), posted by SLS on December 24, 2009, at 11:27:17
Temporary hijack. I keep seeing wellbutrin. If bipolars can take this med how did it create a form of hypomania to me doc at least so he took me off it. Hijack over welcome Alex to babble great to have your here. And the responses you've received are from extremly well informed people. Phillipa
Posted by bleauberry on December 24, 2009, at 15:38:25
In reply to Help w/ atypical depression? (my first post here), posted by Walfredo on December 24, 2009, at 4:03:22
It looks to me like you've already gotten some excellent pointers from everyone else here. If you don't mind, I would chime in with a lot of agreements with them and maybe a couple more tidbits.
The feeling good for a day or two after coming off an SSRI, I totally know that. Why it happens, I'm not sure. I think it may be a sign that the circuitry that needs tweeking is the norepinephrine/dopamine circuit more than the serotonin circuit, though they are all probably involved.
Before I say this, keep in mind I am in no way suggesting anything. I just want to point out that the symptoms of "atypical" depression are almost picture perfect for what psychiatrists should look for when suspecting Lyme disease or candida overgrowth. A Lyme depression looks different than garden variety depression, it looks almost identical to atypical depression. You need not recall being bit by a tick to have Lyme.
Paxil may have continued to work good, and even worked better than ever, if a TCA like Nortriptyline had been added to it. I have no proof whatsoever, but my feeling is that when SSRIs poopout it is because serotonin has finally squashed out NE/DA so much that now there is a new chemical imbalance...too much serotonin, not enough of everything else. It could also be that the body just stop producing serotonin, so an SSRI is kind of like damming up a river that has no water in it. Who knows.
In any case, rounded strategies that hit all the neurotransmitters I believe have better longterm potential. That includes Nardil, Parnate, SSRI+TCA, but NOT Effexor or Cymbalta, since they are mostly serotonin with very little of anything else.
There is also the opioid connection to consider. Some depressions are not serotonin, NE, or DA. These respond profoundly well to things like Codeine and Hydrocodone...the patient feels "normal" rather than high. Someone else without this kind of depression would instead feel either dysphoric, nauseated, or euphoric, but not normal. There are so many stories of people who have tried all the ADs who discovered the best on the planet by a longshot is Tramadol when they were prescribed it for post-op pain or something.
I disagree with the Abilify strategy. Abilify in depression is best known as an augmentor of ongoing SSRIs. By itself, you have to hunt far and wide to find anyone that has found it useful all by itself.
Others like Remeron. I don't. The primary reason is because in my view it seems to have a poopout rate faster than SSRIS. I can't recall anyone who did well with it for long, or anyone that did real well with it period. It is an excellent theoretical discussion drug and clinical trial drug, but in the real world I just don't see it. Much more than anything else, it is one of the planet's most potent antihistamines. Lab tests have shown that it does not increase serotonin and it does not increase norepinephrine. It might be purely the receptor blockade that provides any temporary benefits, similar to what antipsychotics do. I don't know.
California Rocketful. Effexor + Remeron. Years ago this was a fad touted as being a potent combo. The problem is, in the real world we just don't actually see that. If it was such a good combo, it would be very commonly seen and talked about. But it isn't. I did know one person here many years ago that had a multi-year run on complete remission with the combo, but other than that, nada. I just don't feel Remeron lives up to the armchair hype or the clinical trials when it is tried on real patients.
A hospital in Boston added high doses of SAMe to stable doses of Lexapro and had significant results in the majority of their trial patients. SAMe is kind of hit-and-miss, like anything else. It can work fantastic or not at all. When it works, it usually does so within days. Worth a try with that in mind...but not by itself...with an AD. Nature's Way is top quality. I know a couple people at other forums that do not want pharmaceuticals for their Lyme depression and have pretty much resigned to dealing with rather than treating it, but they use SAMe on an as-needed basis on unusually bad days or strings of days. I've done the same. It can lift me out of a hole fast. I get other problems with it longterm, related to prior antipsychotic usage or Lyme, but for a quick fix stepping stone, it is reliable.
Sleep deprivation improvement, in my unsupported opinion, points again to the NE/DA circuits.
Parnate.
Paxil with Nortriptyline or Desipramine.
Zoloft or Lexapro with Nortriptyline.
Zoloft or Lexapro with Desipramine.
Tramadol.
Savella with any of the above.
If you could manage it, get a sample dose of hydrocodone just to test your response. It could tell you a lot.Those are the approaches I would favor for you.
Savella is a new drug for fibromyalgia. In the rest of the world it is a longstanding antidepressant called Milnacipran. Not new. Just in USA. It is one of the top 3 meds in Japan, commonly combined with Paxil or Luvox. It is a true SNRI...1 part serotonin to 2 parts norepinephrine. But that is too simplistic. It is unique in its method reuptake inhibition. Hey, nearly all psych meds made me feel worse, ECT did not work, but Savella pulled me out a slump fast. That has to say something. I believe it is an unsung hero waiting to be discovered. I think the biggest mistake people make with it is taking it as monotherapy, ramping up doses too fast, and not giving it enough time because they increased the dose too fast. I believe its true strength is as part of a combination.
I could get into a whole new topic explaining how to easily test various biological causes of your symptoms, but that is another story. For now the focus is on symptom control. More work can be done after that to figure out why all this happened in the first place.
The mention of Lyme was just a casual mention, but it has to mentioned and considered as a potential player anytime these things are present:
1. Resistant to treatment.
2. The cluster of symptoms you described.
Posted by ace on December 24, 2009, at 17:38:19
In reply to Re: Help w/ atypical depression? (my first post here), posted by West on December 24, 2009, at 8:50:21
> 'Finally, another phenomenon I have CONSISTENTLY experienced is that when I come off SSRI's, I feel better for like a day or two.'
>
> All SSRIs are indirectly anticholinergic so you experienced cholinergic rebound, which feels good, (before you inevitably relapse into hellish depression).I have not heard of cholinergic rebound producing a good feeling. I have heard of it causing depersonalization problems, which, when not associated with phobic anxiety, could produce a relaxed, dreamy sensation.
I would also assume this applies to the shorter acting SSRI's
> Could be lessened REM sleep suppression making you feel better slept/more restored (like back in the day when you were young and unconflicted)What accounts for the lessened REM sleep again?
Posted by West on December 25, 2009, at 15:21:52
In reply to Re: Help w/ atypical depression? (my first post here) » West, posted by ace on December 24, 2009, at 17:38:19
I don't know much about it, except that there's a bit of see-saw effect with serotonin/choline.
Posted by West on December 25, 2009, at 15:41:47
In reply to Re: Help w/ atypical depression? (my first post here) » West, posted by ace on December 24, 2009, at 17:38:19
SSRIs...
Posted by West on December 25, 2009, at 16:06:36
In reply to Re: Help w/ atypical depression? (my first post here) » West, posted by ace on December 24, 2009, at 17:38:19
Cholinergic rebound. I've heard the term used to describe the phenomenology of feeling better 1-2 days immediately after stopping SSRIs. I don't know whether it is correct.
I have however heard that drugs that increase aCH like piracetam can be depressogenic, which seems to be what you're getting at.
I pulled up a study from google. You can see that CDP-choline, I assume used to mimic aCH, produced a mild increase in DA in the brain, either through promoting synthesis/uptake or inhibiting the release of DA from the neuron. Take that to mean what you will.
www.journalarchive.jst.go.jp/jnlpdf.php?cdjournal=jphs1951&cdvol=31&noissue=1&startpage=47〈=en&from=jnlabstract
Posted by Walfredo on December 27, 2009, at 2:53:25
In reply to Help w/ atypical depression? (my first post here), posted by Walfredo on December 24, 2009, at 4:03:22
Hey guys,
I'm back. Holiday functions have prevented me from checking back in until now. I hope a few of you might be willing to hop back into this discussion a bit. I appreciate all the feedback I have gotten so far, especially Ace and bleauberry have gone above and beyond. bleauberry sounds like an MD! I'm gonna try to get into answering all the specific questions that were thrown my way. I also have a few follow-up questions to some comments that were made.
One other potential factor I failed to mention in my initial post is the whole Mitral Valve Prolapse issue which is pretty controversial/debated in itself. Long story short, I have a very mild case (nothing threatening as far as heart structure goes) but apparently this disorder may or may not be related to a specific form of nervous system dysfunction that (if its really a legitimate disorder/link) correlates pretty strongly with my set of symptoms - fatigue is my number one complaint and that seems to be consistent with MVP-syndrome. I get the sticking/stabbing chest pains, etc. Still, even if I do have this MVPS, they say that like 70% of MVPS patients are also depressed so depression is likely still a major factor with me. Anyone unfamiliar with this disorder should check out: http://www.mitralvalveprolapse.com/
-As far as Paxil withdrawal went, yes it was pretty much hell. Basically, mine consisted of extreme worsening of my depressive symptoms - those I have already mentioned (energy, concentration, memory etc.)
-For my Nardil trial, how fast did I go up to 60 mg? Jus checked. I was one 60 mg for just at 2 weeks. I think my thinking was that (after reading on here) optimal dose probably equal to body weight in kg. So, that would be approaching 90+. I figured it was probably safe to go up to 60 pretty quickly. I stayed there for close to 5 weeks with no noticeable improvement. And yes, I split doses (half in morning/half 12 hours later). I did not take any other medications in conjunction with it. I have always been about taking the least possible medications. Also, I wanted to get a good baseline for what effects, if any, Nardil would have. In hindsight, I could have probably tried taking something to sleep better but the thought of having to take a pill to sleep scares the hell out of me and seems completely unnatural. My heart goes out to anyone with true insomnia because I experienced it on Nardil and it was a terrible experience.
-As far as the abilify goes...I said I may feel slightly worse. If so, it is marginally worse, but there is certainly no improvement. I have been at 5 mg for 10 days now. And defending my doc's choice at going here, I feel like she maybe wanted to get a baseline for what Abilify would do for me alone before possibly using it on conjunction with something else.
-As far as sleep deprivation goes, someone asked if there was any "rebound depression". Yes, whenever I go back to sleep is the simple answer.
-Ace, I know you are a major proponent of Nardil (you;'re the "Nardil King" right? Yes, I have seen some of those posts). My drawback with them has been the side effects. I want to find something that works with the least severe side effect profile as possible. If MAOI's are all that can work for me, I may try to tolerate the side effects but as of now, there are other options and my experience with MAOI side effects was miserable. Couldn't sleep. Couldn't get get an erection (sorry to be blunt). Not to mention having to take it twice daily and the diet. Just way too high maintenance considering there are other options and considering Paxil did work for me once.
-Someone asked if I had tried Wellbutrin. Yes I have in conjunction with Lexapro. I think my doc was trying to recreate a Serotonin/NE combo since I had success with Paxil. This did nothing for me. And oddly, Lexapro upset my stomach pretty good while its supposed to have some of the least side effects from what I hear.
-I am curious to hear more theories about Lyme depression and/or candida. Candida couldn't really be a major cause considering the chronic and longstanding nature of my issues though I would think. I sort of feel the same about Lyme though I admittedly know very little about it. I will say that I have a first cousin who has similar "issues" and as far as the family knew, he has/had "Lyme disease" though his symptoms and behavior (became basically agoraphobic from what I understand) suggest more depressive symptomology. From what I gather, he was oversleeping a lot too (like me) so we seem to have similar experiences to some extent. But what are the odds, ticks are responsible for both our experiences, right? Seems dubious.
-bleauberry, why do you suggest sampling hydrocodone? Just curious. Is it supposed to have some anti-depressant qualities? Was this something to do with the opioid receptor deal?
-bleauberry, you also mentioned that you could create a "whole new topic explaining how to easily test biological causes"...so, like, what's stopping you? =)
Thanks again to all of you who have helped with feedback. Knowledge is power and you all are definitely smart and anything you can impart is much appreciated.
Cheers,
Alex
Posted by Phillipa on December 27, 2009, at 19:42:56
In reply to Re: Help w/ atypical depression? (my first post here), posted by Walfredo on December 27, 2009, at 2:53:25
At one time it was thought I also had mitral valve prolapse and my understanding also is not dangerous. Had ultrasound and didn't have it. But was told that thyroid conditions can go with it have you had thyroid testing? Phillipa
Posted by Walfredo on December 27, 2009, at 22:40:53
In reply to Re: Help w/ atypical depression? (my first post here) » Walfredo, posted by Phillipa on December 27, 2009, at 19:42:56
I have had the basic thyroid testing TSH levels but nothing past that. Apparently there can be some subtle abnormalities that simply testing TSH does not detect?
I honestly believe whatever it is, it's not cognitive. Perhaps mental but this has gone on for way too long (and I have changed my defeating thought patterns to the point where I'm Zen-like) for it to be cognitive. I guess it could have originated that way (though I'm skeptical of even that) but whatever is going on is biological. I just gotta find an answer that works....
Posted by Phillipa on December 28, 2009, at 19:22:22
In reply to Re: Help w/ atypical depression? (my first post here), posted by Walfredo on December 27, 2009, at 22:40:53
I tend to agree keep searching I feel we all are. Phillipa
Posted by Walfredo on January 4, 2010, at 22:06:51
In reply to Help w/ atypical depression? (my first post here), posted by Walfredo on December 24, 2009, at 4:03:22
So, I'm starting Remeron tonight. I met with my "pdoc" (is that the term here?) today and we talked. Only had 1/2 hour. I asked straight up if there was a chance I could be Bipolar II. She said that was why she wanted to try the mood stabilizer. And as long as that was the rationale, my confidence in her is restored. If I haven't mentioned it here, I have a few tell-tale signs that might be consistent with a latent Bipolar II (poop out in ~ 1 year of working AD Paxil CR, robust response after only a few days @ 25 mg to Paxil CR that put me in an extremely energetic state, atypical features, etc) even though I say my working diagnosis is Atypical Depression.
So, anyways, I'm still on the Abilify 5 mg with no real impact at about two and a half weeks. I think it might be making me slightly more drowsy but no improvement and if I'm feeling any worse it's only marginally so. I'm adding Remeron starting tonight. I'm wondering if I should just jump straight to 30 mg. I have 15 mg tablets and she said to take "1 or 2" at night with the plan to go to 30 eventually but I guess wanted me to start at 15 to make sure I can tolerate it. I've heard the sedation can be paradoxically worse at 15 than 30 so I'm wondering if I should just go straight to 30 mg (why waste any time if I dont have to?), especially since the other side effects seem mild.
Still, considering I'm on Abilify which can amplify response to ADs (right?) maybe I should just stick with 15 to see if by chance that is an effective dose for me, especially in conjunction with the Abilify. Doc did say that 30 mg is close to the 25 mg equivalent of Paxil CR, which is what worked for me.
I'm also a little but concerned that I haven't given abilify enough of a chance to work on its own merits so the lines could get a bit blurred if I do see some improvement in the near future as far as which agent is responsible for it.
Anyways....just fishing for some feedback or tips for starting Remeron. Crossing my fingers that this might offer some real help.
Cheers,
Alex
Posted by mtdewcmu on January 10, 2010, at 0:26:39
In reply to Update...., posted by Walfredo on January 4, 2010, at 22:06:51
What did you end up doing? I think Remeron is a very good drug. I'm not clear on whether you are currently taking Paxil or not. If you are taking Paxil, you should need a lower dose of Remeron to get the same effects (because Paxil blocks the metabolism of Remeron).
Posted by Walfredo on January 15, 2010, at 17:58:32
In reply to Re: Update...., posted by mtdewcmu on January 10, 2010, at 0:26:39
hey mtdew,
Thanks for following-up. I like your product and would consume massive amounts if I hadn't given up caffeine a couple of years ago.
Anyways, yeah, I am not taking 30 mg of Remeron (for like 11 days) along with 5 mg of Abilify. NOT currently taking Paxil but thanks for the dosage info regardless.
The med combo isn't doing much for me. I definitely have the appetite effect (once I start eating I don't want to stop) but as far as improving my bothersome symptoms, no luck so far. At this point, I am really curious what the Paxil did that no other drug seems to do.
I am also seeing a talk therapist (in addition to the psyche for "medication consultation"). She is suggesting that I try to regulate my sleep patterns and I am throwing that into the mix. I have chronically stayed up late/overslept and even work nights (I think so I could sleep late during the day). So, she thinks I definitely have "idiopathic hypersomnia" in addition to depression issues, so I'm gonna give my best effort into regulating my sleep for a few months. We talked about possibly having a sleep study done. Thing is, there is no telling how these meds are effecting my sleep, so it might not necessarily give a true "base line" for my sleep.
Anyways, that's kind of where I'm at. I guess I'll give the Remeron/Abilify a little more time before it's back to the drawing board.
I may try something like St. John's wort (tho it supposedly isnt much help in dysthymia cases) and SAM-e. Been very curious about both these "natural" cures for some time now.
Alex
Posted by Walfredo on January 15, 2010, at 22:54:07
In reply to Re: Update...., posted by Walfredo on January 15, 2010, at 17:58:32
previous post should read "now taking 30 mg Remeron..." instead of "not"
...just to clear up any confusion if anyone is reading
Posted by Walfredo on January 18, 2010, at 23:23:40
In reply to Re: Update...., posted by Walfredo on January 15, 2010, at 22:54:07
Updating again....
met with the pdoc today and we are discontinuing Abilify so that leaves me with only the Remeron 30 mg for depression. She wants me to increase the dosage to 45 mg but im gonna stay on 30 for a week or so and see if i get any increased benefits since ive only been at 30 mg for two weeks. plus, id like to change 1 variable at a time and since im quitting abilify, ill wait a bit to see how that alters my mood (if it does). If anything, I suspect I will feel slighly less medicated and a bit more pro-sexual.
oh yeah, and she has suggested i try nuvigil for my energy issues which i am open to. i didnt want to use a stimulant and i guess this isnt technically a stimulant but very similar. she gave me some samples and i took one when i left hr office this am (on her advice that it was still early enough to try it out today). it definitely felt somewhat stimulating but there was still and underlying fatigue and poor memory (depression?) underneath it all though i was a bit more productive than usual i suppose. Not a terrible experience but not getting to the root of my problem. definitely a potential helpful "coping med" if i choose to use it longterm.
Thats kind of where im at. Guess, I'll keep updating. Would appreciate any feedback.
Peace,
Alex
Posted by Walfredo on January 26, 2010, at 23:06:21
In reply to Re: Update...., posted by Walfredo on January 18, 2010, at 23:23:40
So here I am again, a week and a half removed from my last meeting with my doctor.
We discontinued the Abilify (I took 2.5 mg for two days) then quit altogether, so I am approximately a week removed from quitting the Abilify. That leaves me at 30 mg Remeron.
I guess there has been some rebound depression though it gets kind of hard to tell when you are already depressed I suppose. It hasn't been too extreme though and altogether, I feel less medicated now and about the same depression-wise.
Glad I quit the Abilify but I'm still searching for relief. I actually had a few moments this past week where I felt something close to no depression for a few moments. It's like you remember what it feels like to feel well for a minute but you can't sustain the feeling. Not sure if this was related to the withdrawal or just random.
I should also mention that my doctor actually mentioned ECT as something we might consider but that we "aren't there yet". That's kind of scary and kind of comforting at the same time. I like that she is willing to be aggressive (and I have to admit I have wondered at times about ECT during some of those desperate times) but it's also ECT so that's scary in and of itself. Plus, from what I have been able to find here on the babble, it really isn't indicated in cases of atypical depression/dysthymia which is the arena I am in with my depression, so it might not even help me anyways. I definitely don't feel "super depressed" but I am definitely frustrated by how I feel and want to do whatever it takes to feel better. So, who knows. What are you guys thoughts on ECT for my situation? Is that reckless at this point or maybe worth a shot?
Nothing major to update I guess. Just wanted to throw the whole ECT thing out there and track my coming off the Abilify.
Any thoughts?
~Alex
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