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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Refractory on November 16, 1999, at 23:17:11
I feel cracked up totally. I have now had major depression for two full years and am only a partial responder to meds. I have been on max doses of Remeron, Zoloft, Wellbutrin SR and Effexor XR for long periods of time. I also tried lithium augmentation which made me worse. I was even in an rTMS clinical trial this year and it didnt help much. Ive had it.
I often wonder what I did to get like this. I mean, before two years ago I was a good guy and liked myself a lot. I still like myself but its like my body has taken a fiesta and wont work normally anymore. The depression wont go away and I am sick of it. Does anybody know of any way to get out of this shit? I cant see living the rest of my life like this. I mean I am basically partially disabled both physically and mentally now. I used to be such a rugged, outdoorsy person and now I feel like I cant do shit anymore hardly.
What did I do to deserve to get like this? God must be pissed at me or something? It is a ridiculous life I lead now.
Posted by JohnL on November 17, 1999, at 3:37:11
In reply to Im cracked up, posted by Refractory on November 16, 1999, at 23:17:11
It's very heartbreaking, and all too common with many of us, to hear your story. My heart goes out to you. Just realize you are nowhere near being the only one dealing with this handicap. Sometimes I think I would be less handicapped if I were undepressed in a wheelchair, rather than depressed on two working legs.
Though you've tried several drugs at therapeutic doses for appropiate amounts of time, there are plenty of options still open. Just from a gut-instinct point of view, I would consider some of the following:
Effexor+Prozac. Prozac. Prozac+TCA (desipramine or nortriptyline). TCA alone. Any of these with Lamictal (instead of Lithium). SSRI+Naltrexone.Basically I still think Prozac is the time-tested powerhorse of the SSRIs, with unique qualities different than the others. I also feel the older TCAs have a certain magic to them, especially when there is disappointing response to the newer ADs you've tried. Often an SSRI+TCA is way better than either alone. Or a TCA+Wellutrin for refractory depression. And of course the MAOIs.
If you were partially satisfied with the Effexor or Zoloft, you might want to go back and retry by combining with a TCA. Or start fresh with one you haven't tried, like Prozac, and add a TCA to it. Effexor+Remeron is touted as being 'big guns'. I know you've tried both seperately, but what about together? There are plenty of options, many being combinations much more effective than anything you've tried yet. I especially like the SSRI+TCA option. Others here find only MAOIs work. And for some the combo of an SSRI+Naltrexone is magic. Another option to consider.
Take what you've learned and move on to better choices. God isn't pissed at you. It's satan to blame for the evils of the world. But that's another thread... In any case, I am wishing you a smooth day. Hang in there. Talk to a doc about the drug options I've mentioned. The right one is just waiting for you to come along. :)
Posted by Refractory on November 17, 1999, at 9:44:43
In reply to Re: Im cracked up, posted by JohnL on November 17, 1999, at 3:37:11
well part of my problem is I cant mix drugs up. Of course, I dont know if I will be able to mix drugs with the older drugs like the TCAs and MAOIs yet cause I have not been on them. But EVERY time I have mixed meds before, I actually got worse. MUCH worse. I have tried mixing the following. Remeron with Zoloft, Remeron with Wellbutrin SR, Effexor XR with Wellbutrin SR, Effexor XR with lithium(lithobid). Every time I mix a med, what little antidepressant response I was getting from the first one if blocked and I get even more depressed...EVERY TIME. I am so sick of this crap. I would love to mix meds if it would work for me,would do it in a heartbeat if it would work. But it doesnt. Yeah, I have heard about the TCA plus SSRI combo plus the TCA plus MAOI combo(wow) but I have yet to try it. I have great hope for the TCAs and the MAOIs. I will be trying Pamelor very soon.
I really am quite cracked up though....like stircrazy in a Chevy Chase movie. Part of me wants to cry, part of me doesnt give a shit anymore and part of me wants to give a sick laugh. Sometimes I have even wondered if all the trauma I have experienced from being told bogus things by a few of my prior psychiatrists has caused me to develop a form of PTSD or something. Some of my shrinks have scared me to death in the past. Not now but in the past they have.
Posted by Tom on November 17, 1999, at 10:28:47
In reply to Re: Im cracked up, posted by Refractory on November 17, 1999, at 9:44:43
> well part of my problem is I cant mix drugs up. Of course, I dont know if I will be able to mix drugs with the older drugs like the TCAs and MAOIs yet cause I have not been on them. But EVERY time I have mixed meds before, I actually got worse. MUCH worse. I have tried mixing the following. Remeron with Zoloft, Remeron with Wellbutrin SR, Effexor XR with Wellbutrin SR, Effexor XR with lithium(lithobid). Every time I mix a med, what little antidepressant response I was getting from the first one if blocked and I get even more depressed...EVERY TIME. I am so sick of this crap. I would love to mix meds if it would work for me,would do it in a heartbeat if it would work. But it doesnt. Yeah, I have heard about the TCA plus SSRI combo plus the TCA plus MAOI combo(wow) but I have yet to try it. I have great hope for the TCAs and the MAOIs. I will be trying Pamelor very soon.
>
> I really am quite cracked up though....like stircrazy in a Chevy Chase movie. Part of me wants to cry, part of me doesnt give a shit anymore and part of me wants to give a sick laugh. Sometimes I have even wondered if all the trauma I have experienced from being told bogus things by a few of my prior psychiatrists has caused me to develop a form of PTSD or something. Some of my shrinks have scared me to death in the past. Not now but in the past they have.You are not alone. I got bothered by things my Pdoc's have said to me. I read your post and said "that's me". God must be pissed at me. JohnL put it best. Its Satan who is in charge of the evil in this world. At least that's my belief. Hang in there and fight the good fight.
Posted by JohnL on November 17, 1999, at 18:00:38
In reply to Re: Im cracked up, posted by Refractory on November 17, 1999, at 9:44:43
Hi again Refractory.
Getting little benefit from ADs, or actually getting worse on them as you did, hints at a bipolar condition rather than a pure depression. Based on what you've said, Lamictal took a giant leap into first place as the next trial for you, in my mind. It sounds like treating your symptoms with mood stabilizers makes a lot of sense. Lamictal is a very friendly one, and is gaining notice as having respectable antidepressant qualities. I just get real suspect that we're barking up the wrong tree when several ADs don't work at therapeutic doses/times. The reasons to try a mood stabilizer strategy sound compelling to me, based on your comments and your multiple failures on ADs with valid trials. And I think you should look into Lamictal as a first choice. Check out Dr Bobs Pharmacology 'tips' section for more info on Lamictal. Also good research on it at Depression Central. Links will take you there, once you've done a search on Lamictal in the 'tips' section. Check it out. I think you'll like what you read.
Posted by Refractory on November 17, 1999, at 22:20:44
In reply to Re: Im cracked up, posted by JohnL on November 17, 1999, at 18:00:38
> Hi again Refractory.
>
> Getting little benefit from ADs, or actually getting worse on them as you did, hints at a bipolar condition rather than a pure depression. Based on what you've said, Lamictal took a giant leap into first place as the next trial for you, in my mind. It sounds like treating your symptoms with mood stabilizers makes a lot of sense. Lamictal is a very friendly one, and is gaining notice as having respectable antidepressant qualities. I just get real suspect that we're barking up the wrong tree when several ADs don't work at therapeutic doses/times. The reasons to try a mood stabilizer strategy sound compelling to me, based on your comments and your multiple failures on ADs with valid trials. And I think you should look into Lamictal as a first choice. Check out Dr Bobs Pharmacology 'tips' section for more info on Lamictal. Also good research on it at Depression Central. Links will take you there, once you've done a search on Lamictal in the 'tips' section. Check it out. I think you'll like what you read.I dont think so JohnL. I am not bipolar. I only get worse on ADs when I COMBINE antidepressants. Its like they block each other. Dont get worse on just one drug, improve some but not too much. I had to get screened for bipolar to get into the rTMS study. And have been to like 6 psychiatrists, and none said I was bipolar. The fact of the matter is that some of use just dont respond well to meds. I do get a partial response from just being on ONE med. Got a decent partial response from Effexor XR and Wellbutrin SR. I tried lithium and that is similar to lamictal and it actually made me worse. Made me more depressed.
Besides that Ive never had any mania. I sleep normally for a depressed person, dont go on any wild spending or sex sprees. Am actually a quite conservative person. I dont know where you got the idea of bipolar from.
All my symptoms are depression symptoms anyway. Not mania or even hypomania. Unless you consider irritability hypomania.I bet if I went on Lamictal I would be thinking about suicide a lot more, especially if I went on it without an antidepressant.
Posted by Elizabeth on November 18, 1999, at 1:10:23
In reply to Re: Im cracked up, posted by JohnL on November 17, 1999, at 3:37:11
> Prozac+TCA (desipramine or nortriptyline).
Desipramine is probably a better choice - nortriptyline levels are dicey enough without adding a CYP2D6 inhibitor like Prozac.
> Any of these with Lamictal (instead of Lithium).
I like the Lamictal idea.
> I especially like the SSRI+TCA option.
MAOI-TCA is an option as well, if you find a pdoc who has experience with it. One psychopharm I know says he's had good results with Parnate + amoxapine specifically. (Add MAOI to TCA, not the other way; don't try this with clomipramine at all.)
BTW I don't think it's a good idea to jump to the conclusion that a person who hasn't responded well to the antidepressants they've tried (especially if they haven't tried the older ones) is bipolar.
And, "Refractory," I've told you this before: IMHO you're not really treatment-resistant until you've failed to respond to TCAs and MAOIs!
Don't give up. You're not even near the end of the road.
Posted by JohnL on November 18, 1999, at 3:18:31
In reply to Im cracked up, posted by Refractory on November 16, 1999, at 23:17:11
Sorry Refractory. I stand corrected. My gut instincts are usually correct. But when I'm wrong, I'm really wrong.
Regardless, I still stand behind Lamictal for you. It is not similar to Lithium in any way, even though they are both prescribed for similar purposes. There is just no way in advance to predict response to anything. A skeptical outlook might accidentally rule out a real good drug. I also stand behind trying a class of antidepressants not yet tried, like TCAs and MAOIs.
I think Eleizabeth did a wonderful job addressing your post. I hope you encounter the medicine that will help. You've sufferred long enough, yeah? :) JohnL
Posted by Refractory on November 18, 1999, at 11:34:25
In reply to Re: Im cracked up, posted by JohnL on November 18, 1999, at 3:18:31
> Sorry Refractory. I stand corrected. My gut instincts are usually correct. But when I'm wrong, I'm really wrong.
>
> Regardless, I still stand behind Lamictal for you. It is not similar to Lithium in any way, even though they are both prescribed for similar purposes. There is just no way in advance to predict response to anything. A skeptical outlook might accidentally rule out a real good drug. I also stand behind trying a class of antidepressants not yet tried, like TCAs and MAOIs.
>
> I think Eleizabeth did a wonderful job addressing your post. I hope you encounter the medicine that will help. You've sufferred long enough, yeah? :) JohnL
yeah my life has sucked for the past two years
This is the end of the thread.
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