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Dr. Bob is Robert Hsiung, MD,
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Posted by rjlockhart04-08 on June 11, 2012, at 1:17:04
In reply to Psychotic Depression, posted by Exisessentialist on June 10, 2012, at 19:35:14
I have to say this was intresting to research for you because I expeirienced vary similar stuff from substance use.
The medications that maybe would help oyu in this....if you have anxiety and agitated...zyprexa...if still doesnt work go to copazine but usally doctors use all sorts of these newer nueroleptics. TCA antidepressants will benefit you much in this state of feeling low, but of course SSRI treatment is usally the first choice and will move around until they have to use TCA's .
Couple days ago Lucifer was in my thinking, telling me I had to choose his way and he would give me what I desired, i resisted and it vary much felt like all these unreasonable illness started coming up...nasty bronicitus in a couple days, having sores from dry skin, lips turning red....and this is not made up, I actually saw all this manifest in just 2-3 days, spend long hours praying and daydreaming about what was happening and if I should give in to him and he would relieve me of what I was afflicted with. All the symptoms left...after begging these spiritual forces to make them stop. But anyways, lets just keep it simple, head to doctor and ask about nueroleptics good for anxiety aka zyprexa, and then try to work on getting onto TCA.
Much reguards,
rj
Posted by Phillipa on June 11, 2012, at 9:53:33
In reply to Psychotic Depression, posted by Exisessentialist on June 10, 2012, at 19:35:14
A phobia to me is high anxiety if it becomes delusional to the point of hallucinations ie:hearing voices, seeing things that arent there to me only this could be psychotic depression. A good doc should be able to distinguish between the two. What does google searches say? Phillipa
Posted by Exisessentialist on June 11, 2012, at 14:14:47
In reply to Re: Psychotic Depression » Exisessentialist, posted by Phillipa on June 11, 2012, at 9:53:33
I'm on zoloft 200 mg, tryptophan 8 grams and nortriptyline 100 mg at the moment. It hasn't really made a dent in my mood or my phobia but my thoughts have been slightly clearer the past few days. The trouble that I've had in assessing psychotic depression is that the information I've encountered tends not to discuss the nature of the delusions. I know that I don't hallucinate but what constitutes a delusion escapes me a bit at the moment. The two, potentially, useful bits of info I've found are that individuals with psychotic depression tend to know that they're delusional thoughts aren't true, which is not true of me, and that they tend to feel guilty or that they're being punished for past misdeeds, which I do feel although I can't really think of anything I've done to deserve my present difficulties. SO...delusion or phobia? Not sure right now. Oh, the other aspect of psychotic depression is that the individuals tend not to disclose their delusional thoughts, which is sometimes true of me. I've learned that most professionals simply don't want to hear about my concerns about brain damage and haven't taken them seriously, so I no longer discuss it.
Posted by emmanuel98 on June 11, 2012, at 18:48:08
In reply to Re: Psychotic Depression, posted by Exisessentialist on June 11, 2012, at 14:14:47
I think your concern about brain damage sounds more like an obsession or anxiety issue than a delusion. I was very depressed a while back and heard voices telling me to die. I knew they weren't real, but they sounded real. I think this is what they call psychotic depression -- when depression is accompanied by auditory or visual hallucinations or paranoid delusions.
Posted by Phillipa on June 11, 2012, at 20:54:48
In reply to Re: Psychotic Depression, posted by emmanuel98 on June 11, 2012, at 18:48:08
That is scarey I guess don't have this. But gone now arent they? Phillipa
Posted by Exisessentialist on June 11, 2012, at 21:25:46
In reply to Re: Psychotic Depression » emmanuel98, posted by Phillipa on June 11, 2012, at 20:54:48
I hope that those symptoms have subsided for you. My psychiatrist and I came to the conclusion that I do not currently have a case of psychotic depression, although he wants me to consider adding an atypical antipsychotic as an augmenting agent, anyway. I'll be slowly weaning off of the tryptophan and nortriptyline with an aim to returning to wellbutrin, which had worked well for me twice in the past, in five weeks. After having sifted through the archives for the past three hours on the debate as to whether or not atypicals cause brain damage, ironic since it seems I may be trading the fear of it for the actuality, I do not know whether to feel optimistic or terrified. Oh, what a tanbled web we weave...
Posted by Christ_empowered on June 12, 2012, at 12:17:29
In reply to Psychotic Depression, posted by Exisessentialist on June 10, 2012, at 19:35:14
I get psychotic depression. Mine involves voices, agitation, weight change, sleep disturbances, cognitive problems, sometimes hair pulling.
Sad times. I think you have some OCD-ish elements to your sadness, but I don't think its psychotic depression.
Posted by Exisessentialist on June 12, 2012, at 14:59:44
In reply to not psychotic depression, posted by Christ_empowered on June 12, 2012, at 12:17:29
Thanks for the replies, all. Given that I've already tried 5 medications to alleviate this treatment-resistant depression and I don't have psychotic depression would it still be of greater benefit than risk to try an atypical antipsychotic as an adjunctive medication? My psychiatrist seemed optimistic about it but since I've found no definitive answer as to whether the atypicals are neurotoxic or neuroprotective, I'm reluctant and ambivalent. Again, thank you for all the replies. Your support is so appreciated!
Posted by b2chica on June 12, 2012, at 15:35:20
In reply to Re: not psychotic depression, posted by Exisessentialist on June 12, 2012, at 14:59:44
i'd give zyprexa a go.
b2c.
Posted by b2chica on June 12, 2012, at 15:43:23
In reply to Re: not psychotic depression » Exisessentialist, posted by b2chica on June 12, 2012, at 15:35:20
agree with CE.
i've been dx iwth psychotic depression at one time. i had visual and auditory illusions, extreme suicidal ideation, some paranoia and delusions.and the thing about the aud and visual stuff is that after i'd see it, it would register that i KNEW it was not real.
i think that's the difference with psychotic depression is that you know your hallucinations/illusions are not real.
Posted by linkadge on June 12, 2012, at 18:17:17
In reply to Psychotic Depression, posted by Exisessentialist on June 10, 2012, at 19:35:14
Seems your thinking is "borderline". Its theoretically *could* be possible - and you recognize the thoughts as being not necessarily 100% fact.
If they just made treatments that worked and didn't cause all sorts of collateral issues, we wouldn't be forced into these courners.
For psychotic depression, you could try adding an AP, but thats not going to help the core problem much (cognative problems). Fluvoxamine might be an option.
Linkadge
Posted by linkadge on June 12, 2012, at 18:18:29
In reply to Re: Psychotic Depression, posted by emmanuel98 on June 11, 2012, at 18:48:08
I was really depressed and convinced that god hated me - (which is funny because I don't really believe in god now), but they told me it was "psychotic" depression.
Posted by emmanuel98 on June 12, 2012, at 19:17:34
In reply to Re: not psychotic depression, posted by Exisessentialist on June 12, 2012, at 14:59:44
> Thanks for the replies, all. Given that I've already tried 5 medications to alleviate this treatment-resistant depression and I don't have psychotic depression would it still be of greater benefit than risk to try an atypical antipsychotic as an adjunctive medication? My psychiatrist seemed optimistic about it but since I've found no definitive answer as to whether the atypicals are neurotoxic or neuroprotective, I'm reluctant and ambivalent. Again, thank you for all the replies. Your support is so appreciated!
I don't know about the neuro effects, but atypicals worked beautifully for me in getting my depression under control. Unfortunately for me, they also caused rapid, out-of-control weight gain. So I had to stop them all. I now take parnate and lamictal and, in combination with DBT, that seems to be working.
Posted by SLS on June 12, 2012, at 19:39:38
In reply to Re: not psychotic depression, posted by emmanuel98 on June 12, 2012, at 19:17:34
> > Thanks for the replies, all. Given that I've already tried 5 medications to alleviate this treatment-resistant depression and I don't have psychotic depression would it still be of greater benefit than risk to try an atypical antipsychotic as an adjunctive medication? My psychiatrist seemed optimistic about it but since I've found no definitive answer as to whether the atypicals are neurotoxic or neuroprotective, I'm reluctant and ambivalent. Again, thank you for all the replies. Your support is so appreciated!
>
> I don't know about the neuro effects, but atypicals worked beautifully for me in getting my depression under control. Unfortunately for me, they also caused rapid, out-of-control weight gain. So I had to stop them all. I now take parnate and lamictal and, in combination with DBT, that seems to be working.This is a good thing. :-)
Out of curiosity, have you ever combined Wellbutrin with Lamictal?
For me, Lamictal is helpful, but only when it is combined with a tricyclic. Right now, I am taking Lamictal, Parnate and nortriptyline along with Abilify, lithium, and prazosin. I am having good results with this regime, although I would like to see if I can't speed things up a little.
You can add Wellbutrin to Parnate and Lamictal safely.
- Scott
Posted by emmanuel98 on June 13, 2012, at 18:45:18
In reply to Re: not psychotic depression » emmanuel98, posted by SLS on June 12, 2012, at 19:39:38
I took wellbutrin once and had a paradoxical reaction to it. I felt bone-weary and extremely depressed from it, so I stopped after a couple of weeks.
Posted by papillon2 on June 14, 2012, at 2:07:10
In reply to Re: not psychotic depression, posted by emmanuel98 on June 13, 2012, at 18:45:18
I think it would be worthwhile discussing with your doctor the suitability of adding another augmentative medication to the mix.
It sounds like what you might be dealing with are repetative, intrusive thoughts? You can have this without it being psychosis. Lithium is good for taking an axe to these. It did wonders for my suicidal ideation which was constant and so so exhausting.
I had uncontrollable weight gain on Zyprexa but not on Lithium, both of which were used in doses suitable as augmentive agents for MDD. The side effects with Lithium are largely dose-dependent. While weight gain is common with doses suitable for bipolar disorder, at a low dose you -- like me -- may not have that problem.
Posted by SLS on June 14, 2012, at 6:15:37
In reply to Re: not psychotic depression, posted by papillon2 on June 14, 2012, at 2:07:10
> I think it would be worthwhile discussing with your doctor the suitability of adding another augmentative medication to the mix.
>
> It sounds like what you might be dealing with are repetative, intrusive thoughts? You can have this without it being psychosis. Lithium is good for taking an axe to these. It did wonders for my suicidal ideation which was constant and so so exhausting.
>
> I had uncontrollable weight gain on Zyprexa but not on Lithium, both of which were used in doses suitable as augmentive agents for MDD. The side effects with Lithium are largely dose-dependent. While weight gain is common with doses suitable for bipolar disorder, at a low dose you -- like me -- may not have that problem.Nice post.
Did you find that lithium leaves you in a passive state of mind with fewer aggressive impulses? I sometimes wonder if these things contribute to the anti-suicide properties of lithium. Is anxiety a component to your depression? If so, does lithium reduce this as well?
Intrusive thoughts can seem much like having an involuntary conversation between the self and an unwanted, altered self. Ruminations can complicate or amplify this. Treating the ruminations as being part of depression or OCD might help reduce the density of intrusive thoughts. I find CBT helpful in recognizing ruminative, intrusive thoughts when they occur, and perform reality checks that allow for the rejection of these negative thoughts as they are understood to be part of the illness.
- Scott
Posted by papillon2 on June 14, 2012, at 8:51:14
In reply to Re: not psychotic depression » papillon2, posted by SLS on June 14, 2012, at 6:15:37
> Nice post.
Thanks. Once I hit send I was worried that I sounded like a drug rep. Lithium does have it's downsides which I know all too well. I had to cease it after ultra-low doses (125mg-250mg) were causing some scary symptoms of toxicity. That is super rare, though.
> Did you find that lithium leaves you in a passive state of mind with fewer aggressive impulses? I sometimes wonder if these things contribute to the anti-suicide properties of lithium. Is anxiety a component to your depression? If so, does lithium reduce this as well?At 500mg (0.8) I was so passive I couldn't speak or walk very well and sat staring into space, LOL. But yes, at lower doses it seemed to take the edge off feelings of aggression toward myself. The best way I could describe it is that it's calming.
I have problems with anxiety but no formal diagnosis, only melancholic depression. Used to have the appendix w/ PTSD features. The intrusive thoughts are the worst when my depression is ridiculously severe (can't speak, walk).
I am in remission/recovered from anorexia nervosa (lifetime predisposition as it is heavily genetic, I may relapse despite being healthy at the moment). Anorexia is known for having an anxiety element to it.
This I found fascinating (was going to start a thread but figured no one else would be interested: http://www.chw.edu.au/research/groups/psychmed/anorexia_nervosa.pdf
> Intrusive thoughts can seem much like having an involuntary conversation between the self and an unwanted, altered self. Ruminations can complicate or amplify this. Treating the ruminations as being part of depression or OCD might help reduce the density of intrusive thoughts. I find CBT helpful in recognizing ruminative, intrusive thoughts when they occur, and perform reality checks that allow for the rejection of these negative thoughts as they are understood to be part of the illness.Yep! My CBT exercises are a real weapon and have kept me alive when stupidly sick. Well, that and being too sick to kill myself! I find the constant arguing/fighting with the illness exhausting, though, without good medication support.
Thanks for reminding us of CBT. Existentialist -- strongly suggest you look into this if you haven't already. There are free online programs if you can't see someone in person, try http://moodgym.anu.edu.au/ Moodgym has been proven to work in studies.
Posted by Exisessentialist on June 14, 2012, at 13:58:47
In reply to Re: not psychotic depression » SLS, posted by papillon2 on June 14, 2012, at 8:51:14
I didn't expect my initial post to spark so many responses but I thoroughly appreciate them all! I should probably also mention that I'm prone to frequent flashbacks and emotional flooding which can occasionally become so intense that I have to remind myself that I'm not actually experiencing the initial events and that significant time has passed since them. I will give the lithium some consideration. It definitely seems worthwhile from what you've posted and I had been considering using it as an augmentation agent. I think I'll have to wait until I've come off of the tryptophan, though. I'm intensely oscillating on the atypical antipsychotic. On one hand it seems ideal with my current experiences but on the other I'm still too scared of the potential neurotoxic effects. In case you couldn't tell, I'm also prone to indecision.
Posted by linkadge on June 14, 2012, at 20:45:29
In reply to Re: not psychotic depression, posted by Exisessentialist on June 14, 2012, at 13:58:47
Yeah, I really would not take an atypical if you can help it.
Pick an antidepressant that works, and perhaps focus on other cognitive improving strategies - diet, supplements, nootropics.
Linkadge
Posted by phidippus on June 19, 2012, at 17:41:38
In reply to Psychotic Depression, posted by Exisessentialist on June 10, 2012, at 19:35:14
You are talking about obsessional fears and phobias, the domain of OCD.
I recommend treatment with an SSRI that has been FDA approved to treat OCD. The SSRI will also treat your depression. Clomipramine is another drug I would recommend.
Eric
Posted by Exisessentialist on June 23, 2012, at 17:57:17
In reply to Re: Psychotic Depression » Exisessentialist, posted by phidippus on June 19, 2012, at 17:41:38
Okay, so after all the replies I'm thinking of adding wellbutrin to the sertraline I'm currently taking after washing-out the nortriptyline and tryptophan, and augmenting with lithium if need be or even for its neuroprotective properties. I hope that this will significantly address all my symptoms and kickstart my journey to remission. I may try a short trial of methylphenidate to see how I respond before adding the wellbutrin and lithium.
Posted by creepy on June 25, 2012, at 9:12:06
In reply to Psychotic Depression, posted by Exisessentialist on June 10, 2012, at 19:35:14
Poor memory and concentration issues can be symptoms of depression too. I get that so bad sometimes I wonder if I have brain damage =(
Posted by phidippus on June 25, 2012, at 16:23:36
In reply to Re: Psychotic Depression, posted by creepy on June 25, 2012, at 9:12:06
Depression shrinks the hippocampus.
Eric
Posted by creepy on June 26, 2012, at 10:57:27
In reply to Re: Psychotic Depression » creepy, posted by phidippus on June 25, 2012, at 16:23:36
True, Ive seen some studies on that =(
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