![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by yardena on August 17, 1999, at 16:27:01
Here's the deal: I respond to SSRI's and Effexor, but the effect tapers off after a while (my depression is chronic/recurrent). Then, when the dose is increased, I don't tolerate them well and begin to suffer from all kinds of adverse effects like sleeplessness, headache, memory problems, sweating, muscle twitches, etc. Not to mention the sexual effects (you'll notice that I don't call any of these things "side" effects because I believe there are no such things as "side" effects, only desired and undersired effects. Afterall, we are putting serious chemicals into our systems) which are certainly bothersome but not always my primary concern, relatively speaking. So, my doctor suggested augmentation, and at first, each combination worked. First we added thyroid hormone, which was appropriate because my TSH was high. That was fine for a while. Then the effectiveness started to fade. So, we added ritalin, which was appropriate because my sypmtom profile included incredible hypersomnia, which was mostly due to untreated apnea. But I have kept the ritalin because, even though I am not a walking zombie anymore, its augmentation effects were very helpful. But now I am depressed again. And as for the serzone--who knows? After reading some of the online literature, it seems perhaps I should give it a while longer, as it can take a while to be effective. On the other hand, I have had the increased emotionality, tearfulness and suicidal thinking. Like someone who responded to my previous post, I also find myself crying all the time, which hadn't been such a prominent feature of my depression for a while, especially when taking SSRIs, which made it nearly impossible to cry even when I wanted to. My doctor has been trying to convince me to try lithium. Some psychiatrists have begun thinking about the chronic, so-called "atypical"* depression as similar to the depressive component of bipolar disorder and have found that some people with difficult to treat depression have responded well to lithium. Needless to say, I am wary, due to the numerous serious adverse effects that are very common in people taking lithium. What I am looking for here, in this long-winded way, is to hear from people who have taken the lithium-as-antidepressant-augmentor route, and to hear about your experiences. Also, any other successful AD cocktails I should ask my doctor about?
*Want my dissertation on the misnomer of the label "atypical depression"? My totally unscientific and uninformed, yet robustly opinionated, view is that many more women than men experience this form of depression, which includes increased sleep, sensitivity to rejection, and increased eating. I also would venture to guess that the standards for diagnosis of depression were studied primarily on male subjects, as it is clear that the scientific community has only lately come to recognize that men and women are different from each other, and get sick differently and respond differently to medications. Since more women than men tend to suffer from depression, I would also guess that the "atypical" variety of depressive illness is probably far more "typical" or frequent than is the so called "typical" version of major depression. I also have doubts about the link between "atypical" depression and bipolar illness. It seems to me that one of the reasons people with bipolar illness have the "reversed vegetative symptoms", ie increased sleep and appetite, is simply because their bodies are compensating for the deprivations experienced during the manic phase, when many people with this disorder don't sleep or eat enough. That "atypical depression" and the depressive phase of bipolar disorder share some symptoms does not feel to me like a strong enough reason to decide they are related. I AM interested to know (Dr. Bob, can you help with this one?) whether there is any evidence of a familial link between "atypical" depression and bipolar illness. There is no bipolar illness in my family, that I know of. There is plenty of depression, and some tendencies toward obsessive-compulsive patterns, especially around eating and food. There is also one case of alcoholism, which I think was self-medication of a chronic depression after the accidental death of a child, and loss of this person's entire family or origin in Eastern Europe during WWII.
Posted by JohnL on August 18, 1999, at 3:33:59
In reply to running out of AD options...Is Lithium next?, posted by yardena on August 17, 1999, at 16:27:01
Yardena, if previous ADs worked but faded, Naltrexone is a new and not yet well-known augmentation to prevent "poop-out". 25mg usually does it. However, it is difficult to tolerate at first, often requiring starting with small pieces of a broken up pill. If it's going to work, it will work great. If not, you'll know that too. Info is available by looking back in the archives of previous months and checking out all posts by WayneR, who is a success story with Naltrexone.
Lithium is a textbook augmentation. It too will either work or it won't, and trying it is the only way to know.
There is a book called Dysthymia, The Spectrum of Chronic Depression, by Agop Akiskal, a noted international researcher/guru. In it he says depression is highly genetic, yet it doesn't breed true. There are so many various forms of psychiatric conditions. If ancestors have one of them, it is likely descendants will get some form too, but not the same form. In addition, he claims depression has various stages, and that at any point in time we are at just one stage of a continuously moving development. As examples, a major depressive bout may turn into a longterm dysthymia. Bipolar may turn into atypical. Or manic-depression may become evident after years of just depression. There may be alternating cycles of psychosis. Intermingling of selected schizophrenia symptoms at times. Though he attempts to draw clear boundaries between different forms of depression using specific symptoms as criteria, it is obvious that there are no clear-cut boundaries, many gray areas, and it is constantly in change anyway.
As far as drug treatment goes, he says when ADs don't work or create other problems, mood stabilizers are the way to go (such as Lithium, Depakote). Newer ones like Neurontin and Lamictal are good choices as well I think. He also believes many difficulties in treatment are due to physicians' underuse of MAOIs. He likes MAOIs.
Having said all this, I haven't really said much to help. The book was like that too. Because after all, we can never predict what will work. Trying to label our type of depression for drug choice is equally difficult. We just never know till we try and try again until something works, using past success stories as guidelines. You ask some tough questions that need a lot of books just to touch on some possible answers. You are a great thinker and seem to know yourself and your history very well, which is a huge plus in seeking treatment that works. Best to you. JohnL.
Posted by yardena on August 18, 1999, at 9:20:07
In reply to Re: running out of AD options...Is Lithium next?, posted by JohnL on August 18, 1999, at 3:33:59
John, thanks for the advice. I will look for that book.
My concerns about depakote, neurontin, lithium, etc. is what I read about serious adverse effects, both here in "babble" and in the drug info I have looked up online. My concern about the MAOIs, which my doctor has also suggested, is the restrictions, not so much the food, but the inability to use decongestant meds if I have a cold. The reason is that I have sleep apnea and cannot sleep without using the nasal CPAP machine. If my nose is stuffed I cannot breathe or sleep at all. Since I am so relieved to have finally gotten the sleep apnea problem under control, I can't bear the idea of putting that at risk.
At the moment, I think I am going to give this serzone a little more time before making another med change.
Thanks.
Posted by Trey on August 18, 1999, at 20:09:58
In reply to Re: running out of AD options...Is Lithium next?, posted by yardena on August 18, 1999, at 9:20:07
Hi, Yardena. I was just breezing through the posts and the word "lithium" caught my eye. I am bipolar and have been taking lithium for over 10 years now. Although I am rather atypical and on a relatively small dosage, I can tell you from experience that lithium isn't as potentially dangerous as you may have heard. Indeed, lithium is a medication and is foreign to the body, but unlike other psych meds, lithium is basically a naturally occurring salt. The body flushes out lithium that is not needed. Once your doctor prescribes it, you will go in for routine bloodwork to make sure that the levels of lithium in your body are at a therapeutic level. Once that it is determined that your blood lithium level is stable, all you need to do is drink plenty of fluids to flush out any extra. The worst symptoms I have ever experienced is occassional loose bowels and a bit of excessive thirst. Both are a sign from your body to drink more water. Of course, this is info coming from an ordinary person, so you should definitely discuss it with your doctor. I am not sure if lithium will work for you personally, but it's definitely worth a try. Oh, hang on, did I say I was ordinary? I meant to say that I am extraordinary, and so are you. You're a hell of a lot stronger than you think, and you WILL get through this. All of your friends are here to support you, and God is watching over you to make sure you get through this OK. Love yourself.
Posted by yardena on August 18, 1999, at 20:50:24
In reply to Re: running out of AD options...Is Lithium next?, posted by Trey on August 18, 1999, at 20:09:58
Thanks, Trey.
Posted by Cynthia on August 18, 1999, at 22:34:06
In reply to Re: running out of AD options...Is Lithium next?, posted by Trey on August 18, 1999, at 20:09:58
yardena
I don't have much time to type right now, but I'd like to share my story with you. Lithium has done more for my depression than any AD has. I'm bipolar, and it keeps my highs under perfect control. It also helps considerably with my depression. Currently I'm on 600mg of lithium a day. I believe that's a low dose but I don't weigh very much. The only side affects I've experienced is nausea, which does not exist when I take lithium with ginger root (available at any health food store), and acne. I go to the dermatologist for injections for this, and it's a pain being 31 and having pimples. That's it for side affects. I wouldn't be scared of it. I hope the best for you,
Cynthia
Posted by yardena on August 18, 1999, at 23:35:49
In reply to Re: running out of AD options...Is Lithium next?, posted by Cynthia on August 18, 1999, at 22:34:06
Thanks for the encouragement. I don't know whether to continue on the serzone or try the lithium. Part of me believes it is time to try the lithium because it is a different approach altogether and I have been through a number of antidepressants and they all eventually have major limitations, such as pooping out, etc. I have gained a LOT of weight already, because I eat when I am depressed and have been extraordinarily sedentary. And, my skin is already in rough shape from rosacea acne. So, obviously I am not keen on the possibility of lithium related effects of weight gain and acne. Also, the effexor makes me have bladder problems and I worry that the lithium will add to this because you have to drink a lot and, so I hear, need to urinate a lot.
I just read an article that talks about how depression worsens if not treated early. I think things are worse for me because all these years on antidepressants, the symptoms have only been partially ameliorated.
Posted by dj on August 19, 1999, at 1:13:04
In reply to Re: running out of AD options...Is Lithium next?, posted by yardena on August 18, 1999, at 23:35:49
Any comments on this from anyone who has experienced elsewhys???? I'm still trying to get a handle on it, myself, if that's at all possible -- ADs or not....
>>
> I just read an article that talks about how depression worsens if not treated early. I think things are worse for me because all these years on antidepressants, the symptoms have only been partially ameliorated.
Posted by JohnL on August 19, 1999, at 3:45:03
In reply to Re: running out of AD options...Is Lithium next?, posted by Trey on August 18, 1999, at 20:09:58
This is just a general follow-up to these posts. I agree predicted side effects shouldn't rule out a trial of whatever. Based on my own experience of many meds, I can say that side effects and results are often quite different from what was initially expected. What turns out to be a nightmare for one person is a miracle to another. I don't think there is any way to predict side effects or results without a good trial. Indeed the side effects in literature can be daunting, but so often you end up experiencing only one, some, or none of those you read about. You'll only know for sure with a personal trial. Just my opinion. JohnL.
Posted by Elizabeth on August 19, 1999, at 14:52:18
In reply to Re: running out of AD options...Is Lithium next?, posted by yardena on August 18, 1999, at 23:35:49
For unipolar depression, lithium is better as an augmentation drug than used by itself. Actually, if you add lithium to an ineffective or partially-effective antidepressant, there's about a 50% chance that it will become effective.
I take lithium (600mg, with a serum level of around 0.7 mmol/L) along with Parnate. I believe you would need a higher dose of lithium if you were to take it by itself. I've found it enormously helpful, but like I said this is literally a 50/50 thing.
I think I've discussed this elsewhere on the board - take a look at the thread "Your vote to treat ANHEDONIA" (begins 8/14).
Posted by yardena on August 20, 1999, at 16:42:37
In reply to Re: running out of AD options...Is Lithium next?, posted by Elizabeth on August 19, 1999, at 14:52:18
The serzone is clearly not enough, so I am now on a higher dose of effexor. We'll see if I can tolerate it. If not, next stop, Lithium.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
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.