Psycho-Babble Medication Thread 1743

Shown: posts 1 to 4 of 4. This is the beginning of the thread.

 

a question for dr.Bob and experts...

Posted by Erich on December 26, 1998, at 11:51:40

I'd try to be as brief as I can: I' m in a dramatic situation. 6 years ago I fell in a deep anxious major depression due to repetition stresses/failures concurrent the decision to change field of study (I m graduating in mathematics soon).
This depression showed to be resistent to triciclics and triciclics/SSRI combinations. After one year suffering, I tried phenelzine 90 mg/d and it was effective. I knew about MAOI's 'tolerance' effect: for some months my depression was (partially) under control
and phenelzine was very gradually lowered to 30 mg/d. Some months later full depressive symptoms came back. It was sufficent to double at 60 mg/d to partially control it once more. I introduced sodium valproate to augment phenelzine. Nevertheless I started curiously cyclying!!!
Curiously I said, because i m not a bipolar and when I feel better (never more than a month continuously actually!) that only means depressive symptoms are partially under control and life is tolerable, while when I go down to a full depressive condition suffering makes my life untolerable: I used to modify doses during the depressive periods (lasting from a few days up to more than a month) so that I m not sure that remissions from those periods had ever been spontaneous or pharmacological!
All these facts leads to a question I need help to answear to: how come this strange cycling????
Cycling is not anymore tolerable, so that nomore than 2 weeks ago I was close to decide for suicide. I instead highed phenelzine up to 90 and sodium valproate to 1200 mg/d. I succeeded in feeling a bit better one more time: I felt confused on what to do....
I decided ( don t ask me why....) to lower phenelzine down rapidely leaving sodium valproate unchanged... now I m at 30 mg/d phenelzine... anxious symptoms got back from some days (hard continuous headache: I started analgesics to control it, peripherical tension, etc...)
Maybe I wanted to know how was my depression after these years with no phenelzine in my body.... in any case I stopped reducing... I was afraid to get back to full depressive symptoms....
I m confused .... what should I do???
Now my questions to you is:
How would u explain these cycliings?
If there was a patient of yours, whose case was as much similar as u can imagine to the description I made of it, how would you manage now in the therapy? (ex:switch to another antidep, take off phanelzine, augment phenelzine,....)

Thanx very much.
Erich
monteleo@linuz.sns.it

 

Re: a question for dr.Bob and experts...

Posted by racer on December 26, 1998, at 14:57:03

In reply to a question for dr.Bob and experts..., posted by Erich on December 26, 1998, at 11:51:40

Um, I'm not an expert in the sense of having an MD, but I am something of an expert in depression at this point, having suffered from major depression on and off most of my life.

My first question is: What does your doctor say about your monkeying around with dosages? There's an old hindu story about a student being trampled by an elephant because he knew that God was in the elephant, but forgot that God was also in the handler who was yelling for him to get out of the way. Maybe you should find God in your doctor and let him/her set your dosages.

The fact that you're changing your dosages so often must have something to do with the cycling you're going through. Most anti-depressants have a cumulative effect, they don't work over night, it takes a steady dose to reach or sustain their effects. It's easy to say that you don't need as much any more, and that you can cut down, but doing so apparently isn't working for you anymore. Maybe your doctor can find an appropriate drug and dosage that will relieve your depression, but the drugs are only effective if you give them an honest chance.

Depression is a living thing. It wants to sustain itself, it doesn't want to have to go back into its little box. Your depression may be cycling in this way at least in part because it's keeping you from really getting a handle on it. You have to be stronger than it is, which is very very frightening.

Also, though you say that you're not bipolar, have you been evaluated lately? The situation you describe, lowering and raising dosages on your own, sounds hypomanic to me. I'm sure one of the doctors here will correct me, but feeling as though you don't really need as much of the drug is kind of a first cousin to feeling as though you can jump off a building and fly: it's different, but related.

Good luck to you, I hope you find relief.

 

Re: a question for dr.Bob and experts...

Posted by Toby on December 30, 1998, at 9:31:03

In reply to Re: a question for dr.Bob and experts..., posted by racer on December 26, 1998, at 14:57:03

First: Don't monkey with your antidepressant dose and don't let anyone else doso either unless it is your doctor taking you completely off it to change to something else. We used to think that depression could be treated with a high dose of medication for 2 or 3 months and then the dose could be lowered dramatically for another few months and then stop it and the depression would not return. We now know that the dose that gets you well is the one that keeps you well. We also know that if depression returns more than once in a person's lifetime that it will most likely continue to return over and over unless the person stays on medication forever (hate that word but it is true).

Second: You need a careful evaluation to determine if this cycling is due to an inadequate dose of medication (and that is common) or is due to a less severe form of bipolar disorder called cyclothymia (just means you never get real high). If you don't have bipolar or cyclothymia, the depakote is probably not helping very much in the way of augmenting the MAOI. Some treatment recommendations to talk with your doctor about: add lithium up to 900 mg per day and if no response add synthroid up to 50 mcg per day and if no response stop both of those and add a tricyclic and if no response change to a different MAOI and if no response go to ECT.

 

Re: a question for dr.Bob and experts...

Posted by Carlo on January 2, 1999, at 7:57:46

In reply to a question for dr.Bob and experts..., posted by Erich on December 26, 1998, at 11:51:40

> I'd try to be as brief as I can: I' m in a dramatic situation. 6 years ago I fell in a deep anxious major depression due to repetition stresses/failures concurrent the decision to change field of study (I m graduating in mathematics soon).
> This depression showed to be resistent to triciclics and triciclics/SSRI combinations. After one year suffering, I tried phenelzine 90 mg/d and it was effective. I knew about MAOI's 'tolerance' effect: for some months my depression was (partially) under control
> and phenelzine was very gradually lowered to 30 mg/d. Some months later full depressive symptoms came back. It was sufficent to double at 60 mg/d to partially control it once more. I introduced sodium valproate to augment phenelzine. Nevertheless I started curiously cyclying!!!
> Curiously I said, because i m not a bipolar and when I feel better (never more than a month continuously actually!) that only means depressive symptoms are partially under control and life is tolerable, while when I go down to a full depressive condition suffering makes my life untolerable: I used to modify doses during the depressive periods (lasting from a few days up to more than a month) so that I m not sure that remissions from those periods had ever been spontaneous or pharmacological!
> All these facts leads to a question I need help to answear to: how come this strange cycling????
> Cycling is not anymore tolerable, so that nomore than 2 weeks ago I was close to decide for suicide. I instead highed phenelzine up to 90 and sodium valproate to 1200 mg/d. I succeeded in feeling a bit better one more time: I felt confused on what to do....
> I decided ( don t ask me why....) to lower phenelzine down rapidely leaving sodium valproate unchanged... now I m at 30 mg/d phenelzine... anxious symptoms got back from some days (hard continuous headache: I started analgesics to control it, peripherical tension, etc...)
> Maybe I wanted to know how was my depression after these years with no phenelzine in my body.... in any case I stopped reducing... I was afraid to get back to full depressive symptoms....
> I m confused .... what should I do???
> Now my questions to you is:
> How would u explain these cycliings?
> If there was a patient of yours, whose case was as much similar as u can imagine to the description I made of it, how would you manage now in the therapy? (ex:switch to another antidep, take off phanelzine, augment phenelzine,....)
> Thanx very much.
> Erich
> monteleo@linuz.sns.it

Dear Erich,
I must say if I was you I d be in the same situation. I surely wouldn t trust any particular psychiatrist, I d just trust myself. I m a psychiatry working on bipolar deseases from 20 years, but as far as I see you are just enough smart
and potentially prepared to make a choice by yourself on what s a better medication for you: I know a lot of collegues of mine will be angry at me after this post, but believe me, that s only an ethical matter: if you are prepared enough
noone can be a better therapist then yourself, it doesn t matter you being a doctor professor or whatever. Psychiatry nowaday is an easy to learn subject, a non-rationalistic pragmatic way of alleviating suffering, it s a collection of drugs,
and no matter what my collegues say, who makes experience on hisself is the better expert in this subject: you only need to take care about possible interaction risks ...

OK, now, you have 2 ways to react to your problems:
- hard manners: augmentation of Nardil (I m sure you can find out by yourself the most effective ways ... example psychostimulants... I d maybe try dextroamphetamine starting with low doses... remember to be careful on the possible risks, one way you can protect yourself is going to a psychiatric center everyday letting them know what you are doing : they are forced to take care of the risks u are takin that way!!! )
- soft manners: try an underregulation of mood stability taking off as much AD as you can from your therapy and put as much mood stabilizer as you can: I d maybe take NArdil off completely.

See what happen, choose one of these 2 ways to react, and whatever you choose, just push it as deep as you can with the amount of drugs: don t listen to specialists who tell you to be slow and moderate in your approach to therapy: think about it as a war: how would you fight a war if you wanted to win it ? Brain, strategy, determination and ... no fearness!

dr Carlo
psychiatrist neuroscientist

mantegaz@cibs.sns.it


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] 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.