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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by cathy y on May 26, 2000, at 23:08:52
Hello fellow sufferers. There certainly seem to be lots of us out there. I'm a "double depressive" -- dysthymic since the start of adolescence (I now know), and first major depression (atypical)about 8 years ago. That (and reading "Listening to Prozac") finally pushed me to ask my GP about an antidepressant. (Several years before I'd tried desipramine, but was scared off with blurry vision). With 50mg of Zoloft my life was transformed -- finally felt like a cheerfully-capable adult instead of gauche teen; enthusiastically did many things -- new garden, artwork, long-put-off chores -- and my doctor remarked on my new confidence, which I hadn't even noticed. Two years with the occasional short crash -- and then it failed me, and I found myself back in an even deeper hole. Wish I'd bumped up the dose -- however, my doctor left and with a new unkown, I started again with Prozac, to little avail. Now 5 years later, 2 with a wonderful young doctor with some mental health experience, I've been trying my damnedest to regain that, with only partial success. (I was trained as a scientist and have been rigourous in following doses and patient with continuing for the dreadful length of time they all take -- sheer curiousity as much as anything). All the SSRI's I tried made me sleepy; Wellbutrin was partially successful; high dose of Zoloft as well. Finally the best approximation I have had is an awful lot: 300mg Zoloft (at bedtime), 300mg Wellbutrin, and 40mg Ritalin. (Which, to my disappointment, didn't give me the slightest bit of a high, just a bit of perking up). But I'm still pretty dreary, and the worst is being so unenthusiastic about everything -- nothing much gives me pleasure or even satisfaction, and I'm really worried. I know I have an artist's eye (I'm reassured), and it's agony not to have the ideas, the drive, the fun of making, or even the surprise captivation by a trick of light or colour etc. ANYWAY, it occurred to me taking these three seems to be covering the three major neurotransmitters so would it be fitting to try an MAOI, Parnate particularly? And, if so, how on earth am I going to be able to withdraw these drugs with minimum fuss? Does anyone have any ideas? Thanks, Cathy
Posted by Noa on May 27, 2000, at 10:59:21
In reply to Withdrawal from three drugs., posted by cathy y on May 26, 2000, at 23:08:52
Cathy, have you had your thyroid checked, and what were your numbers?
Posted by cathy y on May 27, 2000, at 21:49:37
In reply to Re: Double Depression, posted by Noa on May 27, 2000, at 10:59:21
> Cathy, have you had your thyroid checked, and what were your numbers?
Thanks Noa -- oops, yes, forgot to mention that I have tried augmenting with thyroid (Cytomel up to 75 mcg/day) without help. Actually bumped up to 50mg Ritalin a couple of days ago and doing better, but hate taking so much...wonder what would happen if I started by dropping all three a little bit at once?
Posted by SLS on May 28, 2000, at 21:06:00
In reply to Withdrawal from three drugs., posted by cathy y on May 26, 2000, at 23:08:52
> Hello fellow sufferers. There certainly seem to be lots of us out there. I'm a "double depressive" -- dysthymic since the start of adolescence (I now know), and first major depression (atypical)about 8 years ago.
> All the SSRI's I tried made me sleepy; Wellbutrin was partially successful; high dose of Zoloft as well. Finally the best approximation I have had is an awful lot: 300mg Zoloft (at bedtime), 300mg Wellbutrin, and 40mg Ritalin.
> ANYWAY, it occurred to me taking these three seems to be covering the three major neurotransmitters so would it be fitting to try an MAOI, Parnate particularly?
> And, if so, how on earth am I going to be able to withdraw these drugs with minimum fuss? Does anyone have any ideas? Thanks, Cathy
-Hi Cathy.
MAO inhibitors would certainly make a good choice at this point. I am a big proponent of their use, as they have been underutilized in the past. Parnate might be the one to go with, seeing as how it has some amphetamine-like qualities, and you seem to get be helped by both Wellbutrin and Ritalin. However, this is highly speculative. Nardil may work as well, if not better. It is often hard to predict. Another reason why you might want to try Parnate first is that it usually produces fewer side effects and is easier on the liver. Right now, I'm having a hard time deciding for myself which one I should try next. I've been on both.
Is there any social anxiety involved? OCD? Panic attacks?
Do any members of your family have bipolar disorder?
Double-depression can be difficult to treat, as the dysthymic component is often very stubborn. For what reasons have you been diagnosed as having double-depression? From what I can see, an alternative explanation may be indicated. Perhaps you suffered an onset in adolescence of a mild to moderate depression that later developed into a more severe depression - both presentations being different degrees of the same disorder, major depression. If you are a double-depressive, then both components remitted completely with your first treatment using 50mg of Zoloft. That's pretty good. When Zoloft stopped working for you, did you relapse into major depression (go all of the way down) or sink to a level comparable to the depression you experienced in adolescence? You describe experiencing the former rather than the latter. In addition, you have not experienced a period of stable dysthymia since the onset of severe depression. It doesn't sound like you have double-depression. While this may seem like a moot point at the moment, this distinction may have some utility as you progress through different treatments.
Of course, I really don't know. I am not a doctor. I am just making a few observations.
I am not advocating that you put off using an MAOI, but there are a few good drugs that you have not cited. It may not have been your intention to list everything you have tried (many of the lists one finds here are pretty long). If you have not tried Effexor, you may want to consider it. Even if it is only partially effective, it can make a good base for adding Wellbutrin, Remeron, or Serzone. Actually, Wellbutrin makes a good augmenting agent for just about anything, including MAOIs. Personally, I don't find MAOIs to be such a big deal to use.
By the way, it sounds like you have a good doctor. He should be capable of designing a schedule for you to wean off of the drugs you are currently taking. Actually, I would be tempted to keep the Ritalin.
Don't forget, you can add stuff to Parnate too, including Ritalin.
Good luck.
- Scott
Posted by johnturner77 on May 30, 2000, at 8:49:39
In reply to Re: Double Depression, posted by Noa on May 27, 2000, at 10:59:21
I'm not a Doctor(should be obvious!! 8>) ) but if the SSRI's make you sleepy, it seems to imply that you are getting plenty of Serotonin activity, possibly too much. The fact that you respond so poorly to Ritalin implies a resistance to Dopiminergic stimulation. The Prozac has considerable depressive effects on Dopamine, even causing Parkinsonism in some people. Dopamine is closely connected to the reward system in the brain. If this system isn't working correctly, the resulting apathy may resemble depression. IMHO, if someone doesn't respond well at the upper range of standard doses adding another with a similar mode of action, seems inadvisable.
Why not keep the Ritalin levels up while cutting out most of the SSRI type meds? This might ease the trip through the valley of the shadow while you get yourself cleaned out for a trial of the MAOs.
The dietary restrictions necessary with MAOs are all because of of the "A" receptor. Instead of adding more stimulants, would it work for some people to add some MAO-B selective drug like Deprenyl to the Parnate? This might reduce the effective dose of Parnate. ??
The more I read of the research the more cautious I become. A few more Research papers and I will probably burn my soap box. 8>)
Posted by Noa on May 30, 2000, at 13:04:37
In reply to Re: Double Depression, posted by johnturner77 on May 30, 2000, at 8:49:39
I don't recommend it. For ritalin, I would suggest tapering off slowly. Despite it being a short acting drug, sudden discontinuation could cause a rebound depression. I don't know about withdrawal of T3. It is short-acting, too, but I know when I went of thyroid meds for a week a couple of years ago, I felt awful. Then again, it had been working for me.
When you are on T3, do your thyroid test numbers change? Have you considered trying T4? Have you considered a consult with an endocrinologist?
Have you considered a different stimulant?
You may have already addressed this, sorry if I spaced out on it--any possiblity of a sleep disorder?
Finally, a word of commiseration--double depression stinks. It really really stinks.
This is the end of the thread.
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