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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by KarenRB53 on September 13, 2016, at 16:31:31
Anyone been diagnosed with Dysthymia? I've been looking for information on whether certain antidepressants work better than others for this form of depression than major depression. Been off all meds for about 6 months but have to go back on something.
Thanks for opinions and suggestions.
Karen
Posted by SLS on September 13, 2016, at 17:14:40
In reply to Dysthymia, posted by KarenRB53 on September 13, 2016, at 16:31:31
Hi.
I made a few suggestions here:
http://www.dr-bob.org/babble/20160819/msgs/1092093.html
I'm sure you know that dysthymia can be particularly stubborn to treat.
I know a woman who has dysthymia and infrequent episodes of major depression. She does reasonably well with Wellbutrin + Abilify. I would like to see her add Lamictal, but she is reluctant to try it again, mainly because monotherapy was not very helpful.
I wonder if intranasal ketamine would hit the target. Another friend of mine has achieved remission using intranasal ketamine. Her depression was rather severe, but she responded partially using a combination of Abilify and Lamictal.
There are so many possibilities. Traditionally, dysthymia has been treated the same way as major depression. Personally, I am not aware of an association between dysthymia and a list of drugs that are most effective to treat it. Quite awhile ago, several people here were treating their dysthymia with a drug called amisulpiride (Solian) that is available in Europe. Early studies showed that low dosages (25-100 mg/day) were tailored for dysthymia, while higher dosages were necessary to treat schizophrenia.
Wellbutrin + Lamictal + Abilify?
I don't like piling up drugs. But, you gotta do what you gotta do. Since no one drug acts on all of the targeted biological sites necessary to produce a therapeutic response, one needs to use multiple agents.
Out of curiosity, what are some of the treatments you have tried so far?
- Scott
Posted by KarenRB53 on September 13, 2016, at 17:42:50
In reply to Re: Dysthymia » KarenRB53, posted by SLS on September 13, 2016, at 17:14:40
> Hi.
>
> I made a few suggestions here:
>
> http://www.dr-bob.org/babble/20160819/msgs/1092093.html
>
> I'm sure you know that dysthymia can be particularly stubborn to treat.
>
> I know a woman who has dysthymia and infrequent episodes of major depression. She does reasonably well with Wellbutrin + Abilify. I would like to see her add Lamictal, but she is reluctant to try it again, mainly because monotherapy was not very helpful.
>
> I wonder if intranasal ketamine would hit the target. Another friend of mine has achieved remission using intranasal ketamine. Her depression was rather severe, but she responded partially using a combination of Abilify and Lamictal.
>My first antidepressant was Elavil, many years ago. I've been on Prozac which worked well, although it did make me a bit hypo. Added Buspar for that. Tried several TCAs which didn't help. I take meds for high blood pressure so had to work around that. Tried Wellbutrin with Prozac. Lexapro caused anxiety and Celexa worked okay but did nothing for the anxiety. Celexa had least side effects, kind of kept my head above water and maybe that's best I can hope for.
Did lots of counselling.CBT etc.> There are so many possibilities. Traditionally, dysthymia has been treated the same way as major depression. Personally, I am not aware of an association between dysthymia and a list of drugs that are most effective to treat it. Quite awhile ago, several people here were treating their dysthymia with a drug called amisulpiride (Solian) that is available in Europe. Early studies showed that low dosages (25-100 mg/day) were tailored for dysthymia, while higher dosages were necessary to treat schizophrenia.
>
> Wellbutrin + Lamictal + Abilify?
>
> I don't like piling up drugs. But, you gotta do what you gotta do. Since no one drug acts on all of the targeted biological sites necessary to produce a therapeutic response, one needs to use multiple agents.
>
> Out of curiosity, what are some of the treatments you have tried so far?
>
>
> - Scott
Posted by SLS on September 13, 2016, at 18:25:05
In reply to Re: Dysthymia, posted by KarenRB53 on September 13, 2016, at 17:42:50
Why did you stop taking Prozac?
My doctors would love for me to become hypomanic and simply add a drug like Abilify or Saphris to dampen and put a cap on the hypomania.
- Scott
Posted by KarenRB53 on September 13, 2016, at 19:58:32
In reply to Re: Dysthymia » KarenRB53, posted by SLS on September 13, 2016, at 18:25:05
I stopped Prozac the first time because after about 5 yrs or so it stopped working for me. Also gained over 40 lbs but would have kept taking it if it had kept working. Over the years tried several times to go back on it but it was never the same and it would help for a while and stop working. Maybe I should try it again.
Posted by SLS on September 14, 2016, at 1:27:28
In reply to Re: Dysthymia, posted by KarenRB53 on September 13, 2016, at 19:58:32
> I stopped Prozac the first time because after about 5 yrs or so it stopped working for me. Also gained over 40 lbs but would have kept taking it if it had kept working. Over the years tried several times to go back on it but it was never the same and it would help for a while and stop working. Maybe I should try it again.
I would shy away from doing that. Once a SSRI poops out, that's usually the end of its utility. Paxil also has a tendency to poop-out after awhile, but it is a go-to drug if one wants to stay with SSRIs and has already tried Lexapro and Zoloft. Have you tried Effexor or Prestiq?
- Scott
Posted by KayBee01 on September 14, 2016, at 9:16:09
In reply to Re: Dysthymia, posted by SLS on September 14, 2016, at 1:27:28
I did try Effexor however it made my blood pressure go up so doctor stopped that. I've never tried Pristiq.
Posted by Poet on September 14, 2016, at 9:34:13
In reply to Dysthymia, posted by KarenRB53 on September 13, 2016, at 16:31:31
Hi Karen,
One of my official DXs is dysthymia. Lexapro works well for me. I also have anxiety issues so I take Clonazepam as needed and a small dose of Seroquel when I can't sleep. Lexapro is the only med I take daily.
Poet
Posted by KarenRB53 on September 14, 2016, at 10:19:17
In reply to Re: Dysthymia, posted by SLS on September 14, 2016, at 1:27:28
> > I stopped Prozac the first time because after about 5 yrs or so it stopped working for me. Also gained over 40 lbs but would have kept taking it if it had kept working. Over the years tried several times to go back on it but it was never the same and it would help for a while and stop working. Maybe I should try it again.
>
> I would shy away from doing that. Once a SSRI poops out, that's usually the end of its utility. Paxil also has a tendency to poop-out after awhile, but it is a go-to drug if one wants to stay with SSRIs and has already tried Lexapro and Zoloft. Have you tried Effexor or Prestiq?
>
>
> - Scott
Depression is bad, don't even want to get out of bed.....called Drs but can't get in for a week. I was taking Celexa and Wellbutrin back in Feb and still have the Wellbutrin Sr. 100 mg so I'm going to start taking just the Wellbutrin until I see dr. Have to lift this depression.
Posted by KarenRB53 on September 14, 2016, at 11:03:20
In reply to Re: Dysthymia » KarenRB53, posted by Poet on September 14, 2016, at 9:34:13
> Hi Karen,
>
> One of my official DXs is dysthymia. Lexapro works well for me. I also have anxiety issues so I take Clonazepam as needed and a small dose of Seroquel when I can't sleep. Lexapro is the only med I take daily.
>
> Poet
I tried Lexapro when it was first available in Canada. It made my skin and hair so dry that anything I put on my face for moisturizer stung badly so I stopped. Celexa kind of helped, was on it for long time. Maybe Lexapro,would be different now.
Posted by SLS on September 14, 2016, at 12:07:40
In reply to Re: Dysthymia, posted by KayBee01 on September 14, 2016, at 9:16:09
> I did try Effexor however it made my blood pressure go up so doctor stopped that. I've never tried Pristiq.
I don't think Cymbalta (duloxetine) will raise your blood pressure. Like Effexor, Cymbalta is a SNRI.
- Scott
Posted by Jeroen on September 15, 2016, at 5:27:47
In reply to Re: Dysthymia, posted by KarenRB53 on September 13, 2016, at 19:58:32
Karen I suggest you dont retry prozac because its simply pooped out
i had the same with seroquel
Posted by KayBee01 on September 15, 2016, at 9:07:50
In reply to Re: Dysthymia » KayBee01, posted by SLS on September 14, 2016, at 12:07:40
> > I did try Effexor however it made my blood pressure go up so doctor stopped that. I've never tried Pristiq.
>
> I don't think Cymbalta (duloxetine) will raise your blood pressure. Like Effexor, Cymbalta is a SNRI.
>
>
> - ScottWhats your opinion on Wellbutrin? Ive used it before with Celexa but with the two of them my anxiety was too high. Celexa by itself never helped anxiety. Maybe Wellbutrin by itself?
Posted by Christ_empowered on September 15, 2016, at 16:00:59
In reply to Re: Dysthymia, posted by KayBee01 on September 15, 2016, at 9:07:50
hi. I take wellbutrin. I'm on the 2x daily version (SR, its generic now). I take 200 x 2 daily, so 400mgs/day. Its been great for me.
Wellbutrin has a reputation for causing or worsening anxiety, but apparently that's not always what happens. Some people w/ anxiety issues w/ depression actually do well on wellbutrin.
I forget...do you have a benzodiazepine? If so, you could take it as needed for a couple weeks with the wellbutrin (just a thought). For me, wellbutrin made me a bit jittery when the dose was doubled--I went straight from 200mgs to 400mgs/day--but that was minor compared to the benefits.
Hope this helps. Keep us all posted, please.
Posted by Horse on September 17, 2016, at 20:01:15
In reply to Dysthymia, posted by KarenRB53 on September 13, 2016, at 16:31:31
Karen, I'm sorry to hear you're feeling bad. To me it sounds like a major depressive episode on top of dysthymia. Sometimes this is referred to as double depression, although I don't hear that term used often. I was diagnosed with disthymia, (and I think that still hold true), and have had major episodes off and on. I haven't found a drug that treats disthymia, but that doesn't mean there isn't one for you.
Wellbutrin was good and worked for a few years (yay!). It needs to be given some time to work, like weeks, a month or too. If you are in a crisis, like not getting out of bed, maybe your doctor knows something to give you immediate relief?
Lamictal (lamotrigine) has been verrrry helpful, although full effects did not kick in until four-six months (sorry), but maybe your doctor can titrate up while other medications help immediately. I suppose lamictal creates a base to buoy my mood, so that's provided relief from my baseline disthymia.
A stimulant might help, and for me it's Nuvigil. There may be some start up anxiety-- at least there was for me.
Hang in there! Things will get better.
Good therapy helps too :D
Posted by SLS on September 18, 2016, at 8:22:46
In reply to Re: Dysthymia » KarenRB53, posted by Horse on September 17, 2016, at 20:01:15
> Karen, I'm sorry to hear you're feeling bad. To me it sounds like a major depressive episode on top of dysthymia. Sometimes this is referred to as double depression, although I don't hear that term used often.
"Double-depression" is a term used as early as 1982. I don't see it used very much anymore. This might be because it doesn't exist as a formal diagnosis in the DSM. I have seen it in a good friend of mine. She experiences chronic dysthymia (minor depression) punctuated by episodes of severe depression. These episodes are triggered acutely when she is deprived of antidepressants or suffers a systemic infection. Her dysthymia is resistant to various treatments. For now, Abilify + Wellbutrin is helping. I try to encourage her to add Lamictal. She once felt better on Nardil + doxepin. She experienced complete remission on lithium monotherapy for quite a few years. A new doctor she began seeing took her off of lithium because he deemed her to be cured. Unfortunately, she relapsed 3 weeks later. When lithium was restarted, it didn't help at all. This might represent an example of "drug-induced drug-refractoriness". Robert Post posited this as a phenomenon with lithium in the early 1990s.
Wellbutrin + Lamictal + Abilify?
- Scott
Posted by KayBee01 on September 19, 2016, at 8:41:20
In reply to Re: Dysthymia » KarenRB53, posted by Horse on September 17, 2016, at 20:01:15
Thanks so much for opinions and suggestions. I have another appointment with my doctor tomorrow and I'm going to talk about these options.
Karen
This is the end of the thread.
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