![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by shar on December 3, 2000, at 13:43:30
I finally met with a real pyschopharmacologist, hoping at long last that I would be able to get above my depression. My diagnosis is dysthymia (I've heard that before but did not realize it was essentially a death sentence for feeling good). I also have double depression (dys+major depressive episodes) at times. Doc said it is hard to treat, I might be able to find something that will help a little, but in her opinion I was doing quite well.
By this she meant I was not being frequently hospitalized, I was functional in terms of being able to accomplish tasks of daily living, I wasn't trying suicide, etc.
I was hoping for much more. I actually was hoping to feel good. Not Pollyanna good, just good (ie, no cloud over my head, weight on my shoulders, less anhedonia, etc.) more than bad. I have my head above water now, and that's about it. She said that it might be possible to enhance energy level, and help me enjoy occasional moments of pleasure when the situation presented itself.
MEDS. She said she thinks I need higher doses than most people because I smoke. I did some research and it looks like the most common meds that work (or are used for dysthymia) are Zoloft (sertraline), amisulpride, moclobemide (Manerix), and Prozac (fluoxetine). It also appears that researchers believe it can take longer (up to 6 months) for meds to kick in for dysthimics.
I tried Zoloft, the drug from heaven for me and it pooped out really fast. Prozac did nada but I only did 20 mg. Haven't tried the others. Right now I take Effexor XR 300 mg, Wellbutrin SR 200 mg, klonopin to sleep.
I was crying at my lousy prospects of a whole life of depression. She said don't lose hope. My thought was that the most she could do was keep me where I am. You all have any advice, suggestions, etc?
I am planning a physical, and a thorough blood workup.
Don't know if I will go back to her, my first visit was $200.Shar
Posted by Bradley on December 3, 2000, at 16:23:48
In reply to Calling Dysthymics-My recent diagnosis-Help-Long , posted by shar on December 3, 2000, at 13:43:30
I'm in similar shape. I would suggest Parnate as a possibility. It works quite well for me, unfortunatly only for 3 months. I'm trying amisulpride now. It's been about 2 weeks with little help yet. I intend to resume Parnate the first of April. I've been doing this for 8 yrs or so. Parnate for 3 months then it quits helping and then I try other meds hoping I will find some that work as well as parnate and for a longer period. No luck yet. In the long run I'm certain a treatment for my underlying endocrine problem will become available. One can only keep trying and hope for the best. Good luck!> I finally met with a real pyschopharmacologist, hoping at long last that I would be able to get above my depression. My diagnosis is dysthymia (I've heard that before but did not realize it was essentially a death sentence for feeling good). I also have double depression (dys+major depressive episodes) at times. Doc said it is hard to treat, I might be able to find something that will help a little, but in her opinion I was doing quite well.
>
> By this she meant I was not being frequently hospitalized, I was functional in terms of being able to accomplish tasks of daily living, I wasn't trying suicide, etc.
>
> I was hoping for much more. I actually was hoping to feel good. Not Pollyanna good, just good (ie, no cloud over my head, weight on my shoulders, less anhedonia, etc.) more than bad. I have my head above water now, and that's about it. She said that it might be possible to enhance energy level, and help me enjoy occasional moments of pleasure when the situation presented itself.
>
> MEDS. She said she thinks I need higher doses than most people because I smoke. I did some research and it looks like the most common meds that work (or are used for dysthymia) are Zoloft (sertraline), amisulpride, moclobemide (Manerix), and Prozac (fluoxetine). It also appears that researchers believe it can take longer (up to 6 months) for meds to kick in for dysthimics.
>
> I tried Zoloft, the drug from heaven for me and it pooped out really fast. Prozac did nada but I only did 20 mg. Haven't tried the others. Right now I take Effexor XR 300 mg, Wellbutrin SR 200 mg, klonopin to sleep.
>
> I was crying at my lousy prospects of a whole life of depression. She said don't lose hope. My thought was that the most she could do was keep me where I am. You all have any advice, suggestions, etc?
>
> I am planning a physical, and a thorough blood workup.
>
> Don't know if I will go back to her, my first visit was $200.
>
> Shar
Posted by shellie on December 3, 2000, at 18:28:57
In reply to Calling Dysthymics-My recent diagnosis-Help-Long , posted by shar on December 3, 2000, at 13:43:30
> I finally met with a real pyschopharmacologist, hoping at long last that I would be able to get above my depression. My diagnosis is dysthymia (I've heard that before but did not realize it was essentially a death sentence for feeling good). I also have double depression (dys+major depressive episodes) at times. Doc said it is hard to treat, I might be able to find something that will help a little, but in her opinion I was doing quite well.
>Shar. The only reason I believe diagnoses are helpful is for treatment purposes. It is only helpful for the pyschopharmacologist to tell you you have something hard to treat, if it is her intent to aggressively help you find something that will work for your depression.
There are several posters on this board (coming to mind Andrew B., John L, and Adam) who aggressively searched for something to help them and were successful. You should take a lot of encouragement from that. Other posters who found relief dropped off the board and I assume are busy feeling pretty good and living their lives.
You are not doomed to a life of depression, and staying out of the hospital and maintaining stability is not good enough. Nothing has really changed. Someone has just labeled how you already feel. If you go back to this pdoc, what did she offer you in terms of treatment ideas? Did you feel she's be totally committed to getting you better? If so, $200 would be worth it, to at least stay until you are feeling that something is working well for you. If not, there are other specialists in treatment resistent depression.
But please, don't allow a diagnosis to strip you of hope. shellie
Posted by Peter S on December 3, 2000, at 19:23:40
In reply to Calling Dysthymics-My recent diagnosis-Help-Long , posted by shar on December 3, 2000, at 13:43:30
Hey Shar, I know where you're coming from. That has been my diagnosis too and so far I've come up empty after trying many meds. The drugs that I think really might work for me are Parnate and Nardil (Monoamine Oxidase Inhibitors). I tried both of them for a long time and they were effective but at some point they began to wear off and I needed to increase the dose. I could not do this mainly because of the side effect of constipation that I could not find a way to cope with.
If you try a number of the more modern drugs (SSRIs, Effexor, remeron)at adequate doses and times and they don't work, I would really suggest you give the MAOIs a try. I think you can judge how experienced a doc is if they have used MAOIs in relatively high doses (100mg+). I got up to 60mg of Nardil which is pretty low. The main drawback to these drugs is the potential for hypertensive reaction if you go off of the diet of no cheese or other things that have a high tyramine content. I really didn't find the diet a problem. I found Nardil to be more tolerable than Parnate generally- but everyone's different.
Good Luck- I hope you continue to come back and let us know your experiences.
Peter
> I finally met with a real pyschopharmacologist, hoping at long last that I would be able to get above my depression. My diagnosis is dysthymia (I've heard that before but did not realize it was essentially a death sentence for feeling good). I also have double depression (dys+major depressive episodes) at times. Doc said it is hard to treat, I might be able to find something that will help a little, but in her opinion I was doing quite well.
>
> By this she meant I was not being frequently hospitalized, I was functional in terms of being able to accomplish tasks of daily living, I wasn't trying suicide, etc.
>
> I was hoping for much more. I actually was hoping to feel good. Not Pollyanna good, just good (ie, no cloud over my head, weight on my shoulders, less anhedonia, etc.) more than bad. I have my head above water now, and that's about it. She said that it might be possible to enhance energy level, and help me enjoy occasional moments of pleasure when the situation presented itself.
>
> MEDS. She said she thinks I need higher doses than most people because I smoke. I did some research and it looks like the most common meds that work (or are used for dysthymia) are Zoloft (sertraline), amisulpride, moclobemide (Manerix), and Prozac (fluoxetine). It also appears that researchers believe it can take longer (up to 6 months) for meds to kick in for dysthimics.
>
> I tried Zoloft, the drug from heaven for me and it pooped out really fast. Prozac did nada but I only did 20 mg. Haven't tried the others. Right now I take Effexor XR 300 mg, Wellbutrin SR 200 mg, klonopin to sleep.
>
> I was crying at my lousy prospects of a whole life of depression. She said don't lose hope. My thought was that the most she could do was keep me where I am. You all have any advice, suggestions, etc?
>
> I am planning a physical, and a thorough blood workup.
>
> Don't know if I will go back to her, my first visit was $200.
>
> Shar
Posted by SLS on December 3, 2000, at 20:30:21
In reply to Calling Dysthymics-My recent diagnosis-Help-Long , posted by shar on December 3, 2000, at 13:43:30
Sorry, Shar.
This turned out to be longer than I intended. I hope it doesn't cause more confusion rather than less. I just figured I'd look into some things for you. I have no intentions of proof-reading it, so I'll leave that to you.
> I finally met with a real pyschopharmacologist, hoping at long last that I would be able to get above my depression.> My diagnosis is dysthymia (I've heard that before but did not realize it was essentially a death sentence for feeling good).
I'm not sure that it is a death sentence. I like the idea of using Parnate or Nardil at some point as does Bradley. I think adding Ritalin to any treatment combination might help. Double-depression has historically been thought of as being very difficult to treat. It is easier to get rid of the "major" depression than it is the "minor" depression or dysthymia. "Minor" depression and dysthymia are thankfully now being recognized as major, serious disorders with rates of suicide perhaps higher than that of major recurrent depression. Chronicity is a MF.
Is dysthymia a disorder distinct from major depression? Recently, there has been growing debate as to whether they are separate disorders or two different presentations along a "spectrum" of depressive illness. Currently, my reading leads me to believe that dysthymia exists as a separate disorder and that it is often confused diagnostically and nosologically as being a less severe or subsyndromal presentation of major depression. Dysthymia is not the same as "subsyndromal depression". Both exist independantly. Subsyndromal or subthreshold depression does *not* produce anhedonia or depressed-mood. In addition, chronic dysthymia may involve the endocrine system and the immune system to a degree greater than that of major depression. Irregularities of these systems have been observed. A more critical question is whether or not dysthymia is to be treated any differently than is major depression. I do think that there may be some little "tricks" that can help with dysthymia. The first ones that come to mind are the additions of Ritalin and thyroid hormone.
I have always thought of treating double depression as if one were treating two separate disorders. I think it is unreasonable to treat double-depression with just one drug. Once the major depression is adequately treated with a drug regime, keep taking it and forget about it. Now begin treating the residual dysthymia from scratch as if you were addressing it for the very first time, leaving in place the successful treatment regimen for major depression. Anyway, that's how I would approach the situation.
> MEDS. She said she thinks I need higher doses than most people because I smoke. I did some research and it looks like the most common meds that work (or are used for dysthymia) are Zoloft (sertraline), amisulpride, moclobemide (Manerix), and Prozac (fluoxetine). It also appears that researchers believe it can take longer (up to 6 months) for meds to kick in for dysthimics.
Have you ever tried Risperdal or Zyprexa in combination with antidepressants?
I wonder if selegiline (Eldepryl) might help. Selegiline is an MAO-inhibitor that is fairly selective for the dopamine enzyme. Perhaps you can ask AndrewB about that. He has noted that it takes a few months to "kick-in". Perhaps this is indicative of a population of misdiagnosed dysthymics being successfully treated with selegiline.
As far as the drugs you have mentioned, I think drug manufacturers like when someone finds a new use for an old drug. That one drug constantly appears in trials for treating dysthymia is not necessarily an indicator that it is better than other drugs not chosen for testing. I need to look more into this. Certainly, amisulpride looks good based upon what people here have experienced with it.
Has modern medicine been able to exclude certain antidepressants in the treatment of dysthymia because they are consistantly found to be ineffective? I haven't seen anything that supports this notion. Trial and error still seems to be the modus operendus. However, I think using more than one drug is usually necessary.
It may not be so surprising that Zoloft worked so well for you. I came across several studies showing it to be particularly effective in treating dysthymia. If I were you, I would take an inventory of which drugs produced an improvement, regardless of degree or duration. I would then consider choosing from them safe combinations to try. Combinations of Zoloft + Wellbutrin or Effexor + Wellbutrin sound like they might be worth looking at. Don't forget about adding Ritalin or thyroid to either of these.
> I tried Zoloft, the drug from heaven for me and it pooped out really fast. Prozac did nada but I only did 20 mg. Haven't tried the others. Right now I take Effexor XR 300 mg, Wellbutrin SR 200 mg, klonopin to sleep.
Let's see how close you come with this combo. If not totally without positive effect, take note. Prozac sometimes needs to be administered at 60+ mg a day. Likewise, there are some people who need 600+ mg of Effexor. Believe it or not.
If inadequate, perhaps adding Ritalin (or another stimulant) and thyroid (Cytomel and/or Synthroid) might do the trick. If not, I would consider swapping the Effexor for Zoloft, leaving everything else in place.
You might want to consider psychotherapy as an adjunct to medication. Perhaps old and chronic depressive thought styles and stressors are making your chronic dysthymia more resistant to pharmacotherapy. Psychotherapy is actually critical to an integrated treatment plan to kill the dysthymic beast. Do you have an "avoidant personality" or are you particularly avoidant of things and situations you feel might be potentially harmful? Would you consider your home life as a child to be an adverse environment? Do you think you were depressed prior to puberty? Has the term "depressive personality disorder" ever been used?
I know you can get well. Unfortunately, Shar, it will probably not happen by the time you wake up tomorrow morning. :-) Sorry. I wish I could give you some patience, but I can't give you what I don't have. Educated trial and error. You'll get there.
Good luck. I have prayed for you.
- Scott---------------------------------------------------------------
54: Cochrane Database Syst Rev 2000;(2):CD001130A comparison of drugs versus placebo for the treatment of dysthymia.
Lima MS, Moncrieff J
Department of Mental Health, Universidade Federal de Pelotas, Avenida Duque de Caxias, 250, Pelotas, Rio Grande do Sul, Brazil, 96100. mslima@nutecnet.com.br
OBJECTIVES: Dysthymia is a depressive disorder of chronic nature but of less severity than major depression, which depressive symptoms are more or less continuous for at least two years. The aim of this review was to conduct a systematic review of all RCTs comparing drugs and placebo for dysthymia. SEARCH STRATEGY: Electronic searches of Cochrane Library, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; reference searching; personal communication; conference abstracts; unpublished trials from the pharmaceutical industry; book chapters on the treatment of depression. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of drugs versus placebo for dysthymic patients. Exclusion criteria were: non randomised, mixed major depression/ dysthymia (trials not providing separate data) and depression secondary to other disorders (e.g. substance abuse). DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently. In order to achieve an intention-to-treat analysis, when trials failed to report it was assumed that people who died or dropped out had no improvement. Authors of relevant trials were contacted for additional and missing data. Absence of treatment response as defined by authors was the main measure of outcome used. Relative Risks (RR) and 95% confidence intervals (CI) of dichotomous data were calculated with the Random Effects Model. Where possible, number needed to treat (NNT) and number needed to harm (NNH) were estimated, taking the reciprocal of the absolute risk reduction. MAIN RESULTS: Currently the review includes 15 trials. Similar results were obtained in terms of efficacy for different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and other drugs (sulpiride, amineptine, and ritanserin). The pooled RR for absence of treatment response was 0. 68 (95% CI 0.59-0.78) for TCA and the NNT was 4.3 (95% CI 3.2-6.5). SSRIs showed similar RR for this outcome: 0.64 (95% CI 0.55-0.74), the NNT being 4.7 (95% CI 3.5-6.9). Concerning MAOIs, the RR was 0. 59 (95% CI 0.48-0.71) and the NNT was 2.9 (95% CI 2.2-4.3). Other drugs (amisulpride, amineptine and ritanserin) showed similar results in terms of absence of treatment response. Using more stringent criteria for improvement - full remission - the results were unchanged. Patients treated on TCA were more likely to report adverse events, compared with placebo. REVIEWER'S CONCLUSIONS: Drugs are effective in the treatment of dysthymia with no differences between and within class of drugs. Tricyclic antidepressants are more likely to cause adverse events and dropouts. As dysthymia is a chronic condition, there remains little information on quality of life and medium or long-term outcome.
Publication Types:
Review
Review, academicPMID: 10796749, UI: 20257829
------------------------------------------------------------------17: Depress Anxiety 2000;12(1):30-9
Subsyndromal symptomatic depression: a new concept.
Sadek N, Bona J
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
[Medline record in process]
Although DSM-IV acknowledged the clinical significance of some subthreshold forms of unipolar depression, such as minor depression (MinD) and recurrent brief depression (RBD), clinicians continued to struggle with the concept of "subthreshold" depression. A substantial number of patients continued to present with depressive symptoms that still did not satisfy any DSM-IV diagnosis. Generally, these patients failed to complain of anhedonia and depressed mood, a criterion that DSM-IV mandates for any diagnosis of depression. Therefore, researchers reexamined the question of whether this cluster of depressive symptoms, in the absence of anhedonia and depressed mood, was clinically significant. Some researchers labeled this cluster of symptoms, "subsyndromal symptomatic depression" (SSD). Specifically, SSD is defined as a depressive state having two or more symptoms of depression of the same quality as in major depression (MD), excluding depressed mood and anhedonia. The symptoms must be present for more than 2 weeks and be associated with social dysfunction. Using Medline Search, the authors reviewed the literature on the epidemiology, demographics, clinical characteristics, and psychosocial impairment of SSD. SSD is found to be comparable in demographics and clinical characteristics to MD, MinD, and dysthymia. SSD is also associated with significant psychosocial dysfunction as compared with healthy subjects. Further; it has significant risk for suicide and future MD. Few studies have been conducted on the treatment of SSD. The high prevalence of SSD, the significant psychosocial impairment associated with it, and the chronicity of its course make subsyndromal symptomatic depression a matter for serious consideration by clinicians and researchers.
PMID: 10999243, UI: 20454556
------------------------------------------------------------------
: Am J Psychiatry 2000 Dec 1;157(12):1966-1972Three-Year Follow-Up of Women With the Sole Diagnosis of Depressive Personality Disorder: Subsequent Development of Dysthymia and Major Depression.
Kwon JS, Kim YM, Chang CG, Park BJ, Kim L, Yoon DJ, Han WS, Lee HJ, Lyoo IK
[Record supplied by publisher]
OBJECTIVE: The authors sought to determine whether subjects with the sole diagnosis of depressive personality disorder are at higher risk for developing dysthymia and major depression than are healthy comparison subjects. METHOD: Eighty-five women with depressive personality disorder who had no comorbid axis I or axis II disorders and 85 age-matched healthy comparison women were initially recruited and reinterviewed 3 years later to evaluate the cumulative incidence rate of dysthymia and major depression. RESULTS: At the 3-year follow-up assessment, the women with depressive personality disorder had a significantly greater odds ratio for developing dysthymia than did the healthy comparison women. The difference in odds ratios for the development of major depression between women with and without depressive personality disorder did not reach statistical significance. CONCLUSIONS: The present study, the first to determine the subsequent development of dysthymia and major depression in subjects with the sole diagnosis of depressive personality disorder, found that subjects with depressive personality disorder had a greater risk of developing dysthymia than did healthy comparison subjects at 3-year follow-up. Findings of the current study also suggest that depressive personality disorder may mediate the effects of a family history of axis I unipolar mood disorders.
PMID: 11097962
----------------------------------------------------------
23: Am J Psychiatry 2000 Sep;157(9):1436-44Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: effects on personality.
Hellerstein DJ, Kocsis JH, Chapman D, Stewart JW, Harrison W
Outpatient Mental Health Services, Beth Israel Medical Center, New York, NY 10003, USA. dhellerstein@bethisraelny.org
OBJECTIVE: Although previous studies have shown that dysthymia, or chronic depression, commonly responds to antidepressant medications (with improvements in depressive symptoms and psychosocial functioning), there have been no systematic studies of the impact of antidepressant treatment on personality variables in patients with this disorder. METHOD: In a multicenter study, 410 patients with early-onset primary dysthymia were treated in a randomized prospective fashion with sertraline, imipramine, or placebo. The data were analyzed in terms of the subjects' scores on the Tridimensional Personality Questionnaire, a 100-item self-report instrument that measures four temperamental dimensions: harm avoidance, reward dependence, novelty seeking, and persistence. RESULTS: At baseline, the harm avoidance scores of the dysthymic subjects were approximately 1.5 standard deviations higher than those of a previously reported community sample. After treatment, there was a significant decrease in harm avoidance scores, with no significant between-group differences. Remission of dysthymia was associated with significantly greater improvement in harm avoidance, with the greatest numerical change found in the patients treated with sertraline. Subjects' Tridimensional Personality Questionnaire scores were correlated at a 0.50 level with the Social Adjustment Scale both pre- and posttreatment, suggesting that a high degree of harm avoidance may be associated with poor social functioning. CONCLUSIONS: Before treatment, chronically depressed patients demonstrate an abnormality in temperament, as measured by elevated degrees of harm avoidance. Remission of dysthymia is associated with improvement in this aspect of temperament.
Publication Types:
Clinical trial
Multicenter study
Randomized controlled trialPMID: 10964860, UI: 20422057
:-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-)
Posted by shar on December 3, 2000, at 23:50:47
In reply to Re: Dysthymics-My recent diagnosis-Help-Longer » shar, posted by SLS on December 3, 2000, at 20:30:21
Thank you all for responding! I think this p-doc is willing to work with me, and try different things, but I did not get the sense that she was willing to be aggressive in going after a solution. Plus, she said "nobody is happy all the time" and I thought well, DUH, why would she even say that to me? I am an idiot that expects her to come up with a magic potion?!
I don't believe I'll go back to her. My current p-doc is not that knowledgeable, but she is willing to work with me and learn. And, I think will be aggressive.
One of the things that made me believe dysthymia is a fitting diagnosis is that it can commonly begin in childhood and early adolescence, which is when mine began. Plus all the stuff about being viewed by others as pessimistic, not having fun, etc.
She (p-doc) mentioned Lithium I think. And said a thyroid supplement might help.
I am too tired right now to write more, but thanks to you all for your responses. And your research, SLS. You are all very kind and generous.
More later. Shar
> Sorry, Shar.
>
>
> This turned out to be longer than I intended. I hope it doesn't cause more confusion rather than less. I just figured I'd look into some things for you. I have no intentions of proof-reading it, so I'll leave that to you.
>
>
> > I finally met with a real pyschopharmacologist, hoping at long last that I would be able to get above my depression.
>
> > My diagnosis is dysthymia (I've heard that before but did not realize it was essentially a death sentence for feeling good).
>
> I'm not sure that it is a death sentence. I like the idea of using Parnate or Nardil at some point as does Bradley. I think adding Ritalin to any treatment combination might help. Double-depression has historically been thought of as being very difficult to treat. It is easier to get rid of the "major" depression than it is the "minor" depression or dysthymia. "Minor" depression and dysthymia are thankfully now being recognized as major, serious disorders with rates of suicide perhaps higher than that of major recurrent depression. Chronicity is a MF.
>
> Is dysthymia a disorder distinct from major depression? Recently, there has been growing debate as to whether they are separate disorders or two different presentations along a "spectrum" of depressive illness. Currently, my reading leads me to believe that dysthymia exists as a separate disorder and that it is often confused diagnostically and nosologically as being a less severe or subsyndromal presentation of major depression. Dysthymia is not the same as "subsyndromal depression". Both exist independantly. Subsyndromal or subthreshold depression does *not* produce anhedonia or depressed-mood. In addition, chronic dysthymia may involve the endocrine system and the immune system to a degree greater than that of major depression. Irregularities of these systems have been observed. A more critical question is whether or not dysthymia is to be treated any differently than is major depression. I do think that there may be some little "tricks" that can help with dysthymia. The first ones that come to mind are the additions of Ritalin and thyroid hormone.
>
> I have always thought of treating double depression as if one were treating two separate disorders. I think it is unreasonable to treat double-depression with just one drug. Once the major depression is adequately treated with a drug regime, keep taking it and forget about it. Now begin treating the residual dysthymia from scratch as if you were addressing it for the very first time, leaving in place the successful treatment regimen for major depression. Anyway, that's how I would approach the situation.
>
> > MEDS. She said she thinks I need higher doses than most people because I smoke. I did some research and it looks like the most common meds that work (or are used for dysthymia) are Zoloft (sertraline), amisulpride, moclobemide (Manerix), and Prozac (fluoxetine). It also appears that researchers believe it can take longer (up to 6 months) for meds to kick in for dysthimics.
>
> Have you ever tried Risperdal or Zyprexa in combination with antidepressants?
>
> I wonder if selegiline (Eldepryl) might help. Selegiline is an MAO-inhibitor that is fairly selective for the dopamine enzyme. Perhaps you can ask AndrewB about that. He has noted that it takes a few months to "kick-in". Perhaps this is indicative of a population of misdiagnosed dysthymics being successfully treated with selegiline.
>
> As far as the drugs you have mentioned, I think drug manufacturers like when someone finds a new use for an old drug. That one drug constantly appears in trials for treating dysthymia is not necessarily an indicator that it is better than other drugs not chosen for testing. I need to look more into this. Certainly, amisulpride looks good based upon what people here have experienced with it.
>
> Has modern medicine been able to exclude certain antidepressants in the treatment of dysthymia because they are consistantly found to be ineffective? I haven't seen anything that supports this notion. Trial and error still seems to be the modus operendus. However, I think using more than one drug is usually necessary.
>
> It may not be so surprising that Zoloft worked so well for you. I came across several studies showing it to be particularly effective in treating dysthymia. If I were you, I would take an inventory of which drugs produced an improvement, regardless of degree or duration. I would then consider choosing from them safe combinations to try. Combinations of Zoloft + Wellbutrin or Effexor + Wellbutrin sound like they might be worth looking at. Don't forget about adding Ritalin or thyroid to either of these.
>
> > I tried Zoloft, the drug from heaven for me and it pooped out really fast. Prozac did nada but I only did 20 mg. Haven't tried the others. Right now I take Effexor XR 300 mg, Wellbutrin SR 200 mg, klonopin to sleep.
>
> Let's see how close you come with this combo. If not totally without positive effect, take note. Prozac sometimes needs to be administered at 60+ mg a day. Likewise, there are some people who need 600+ mg of Effexor. Believe it or not.
>
> If inadequate, perhaps adding Ritalin (or another stimulant) and thyroid (Cytomel and/or Synthroid) might do the trick. If not, I would consider swapping the Effexor for Zoloft, leaving everything else in place.
>
> You might want to consider psychotherapy as an adjunct to medication. Perhaps old and chronic depressive thought styles and stressors are making your chronic dysthymia more resistant to pharmacotherapy. Psychotherapy is actually critical to an integrated treatment plan to kill the dysthymic beast. Do you have an "avoidant personality" or are you particularly avoidant of things and situations you feel might be potentially harmful? Would you consider your home life as a child to be an adverse environment? Do you think you were depressed prior to puberty? Has the term "depressive personality disorder" ever been used?
>
> I know you can get well. Unfortunately, Shar, it will probably not happen by the time you wake up tomorrow morning. :-) Sorry. I wish I could give you some patience, but I can't give you what I don't have. Educated trial and error. You'll get there.
>
> Good luck. I have prayed for you.
>
>
> - Scott
>
>
>
> ---------------------------------------------------------------
>
>
> 54: Cochrane Database Syst Rev 2000;(2):CD001130
>
> A comparison of drugs versus placebo for the treatment of dysthymia.
>
> Lima MS, Moncrieff J
>
> Department of Mental Health, Universidade Federal de Pelotas, Avenida Duque de Caxias, 250, Pelotas, Rio Grande do Sul, Brazil, 96100. mslima@nutecnet.com.br
>
> OBJECTIVES: Dysthymia is a depressive disorder of chronic nature but of less severity than major depression, which depressive symptoms are more or less continuous for at least two years. The aim of this review was to conduct a systematic review of all RCTs comparing drugs and placebo for dysthymia. SEARCH STRATEGY: Electronic searches of Cochrane Library, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; reference searching; personal communication; conference abstracts; unpublished trials from the pharmaceutical industry; book chapters on the treatment of depression. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of drugs versus placebo for dysthymic patients. Exclusion criteria were: non randomised, mixed major depression/ dysthymia (trials not providing separate data) and depression secondary to other disorders (e.g. substance abuse). DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently. In order to achieve an intention-to-treat analysis, when trials failed to report it was assumed that people who died or dropped out had no improvement. Authors of relevant trials were contacted for additional and missing data. Absence of treatment response as defined by authors was the main measure of outcome used. Relative Risks (RR) and 95% confidence intervals (CI) of dichotomous data were calculated with the Random Effects Model. Where possible, number needed to treat (NNT) and number needed to harm (NNH) were estimated, taking the reciprocal of the absolute risk reduction. MAIN RESULTS: Currently the review includes 15 trials. Similar results were obtained in terms of efficacy for different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and other drugs (sulpiride, amineptine, and ritanserin). The pooled RR for absence of treatment response was 0. 68 (95% CI 0.59-0.78) for TCA and the NNT was 4.3 (95% CI 3.2-6.5). SSRIs showed similar RR for this outcome: 0.64 (95% CI 0.55-0.74), the NNT being 4.7 (95% CI 3.5-6.9). Concerning MAOIs, the RR was 0. 59 (95% CI 0.48-0.71) and the NNT was 2.9 (95% CI 2.2-4.3). Other drugs (amisulpride, amineptine and ritanserin) showed similar results in terms of absence of treatment response. Using more stringent criteria for improvement - full remission - the results were unchanged. Patients treated on TCA were more likely to report adverse events, compared with placebo. REVIEWER'S CONCLUSIONS: Drugs are effective in the treatment of dysthymia with no differences between and within class of drugs. Tricyclic antidepressants are more likely to cause adverse events and dropouts. As dysthymia is a chronic condition, there remains little information on quality of life and medium or long-term outcome.
>
> Publication Types:
> Review
> Review, academic
>
> PMID: 10796749, UI: 20257829
>
>
> ------------------------------------------------------------------
>
>
>
> 17: Depress Anxiety 2000;12(1):30-9
>
> Subsyndromal symptomatic depression: a new concept.
>
> Sadek N, Bona J
>
> Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
>
> [Medline record in process]
>
> Although DSM-IV acknowledged the clinical significance of some subthreshold forms of unipolar depression, such as minor depression (MinD) and recurrent brief depression (RBD), clinicians continued to struggle with the concept of "subthreshold" depression. A substantial number of patients continued to present with depressive symptoms that still did not satisfy any DSM-IV diagnosis. Generally, these patients failed to complain of anhedonia and depressed mood, a criterion that DSM-IV mandates for any diagnosis of depression. Therefore, researchers reexamined the question of whether this cluster of depressive symptoms, in the absence of anhedonia and depressed mood, was clinically significant. Some researchers labeled this cluster of symptoms, "subsyndromal symptomatic depression" (SSD). Specifically, SSD is defined as a depressive state having two or more symptoms of depression of the same quality as in major depression (MD), excluding depressed mood and anhedonia. The symptoms must be present for more than 2 weeks and be associated with social dysfunction. Using Medline Search, the authors reviewed the literature on the epidemiology, demographics, clinical characteristics, and psychosocial impairment of SSD. SSD is found to be comparable in demographics and clinical characteristics to MD, MinD, and dysthymia. SSD is also associated with significant psychosocial dysfunction as compared with healthy subjects. Further; it has significant risk for suicide and future MD. Few studies have been conducted on the treatment of SSD. The high prevalence of SSD, the significant psychosocial impairment associated with it, and the chronicity of its course make subsyndromal symptomatic depression a matter for serious consideration by clinicians and researchers.
>
> PMID: 10999243, UI: 20454556
>
>
> ------------------------------------------------------------------
>
>
> : Am J Psychiatry 2000 Dec 1;157(12):1966-1972
>
> Three-Year Follow-Up of Women With the Sole Diagnosis of Depressive Personality Disorder: Subsequent Development of Dysthymia and Major Depression.
>
> Kwon JS, Kim YM, Chang CG, Park BJ, Kim L, Yoon DJ, Han WS, Lee HJ, Lyoo IK
>
> [Record supplied by publisher]
>
> OBJECTIVE: The authors sought to determine whether subjects with the sole diagnosis of depressive personality disorder are at higher risk for developing dysthymia and major depression than are healthy comparison subjects. METHOD: Eighty-five women with depressive personality disorder who had no comorbid axis I or axis II disorders and 85 age-matched healthy comparison women were initially recruited and reinterviewed 3 years later to evaluate the cumulative incidence rate of dysthymia and major depression. RESULTS: At the 3-year follow-up assessment, the women with depressive personality disorder had a significantly greater odds ratio for developing dysthymia than did the healthy comparison women. The difference in odds ratios for the development of major depression between women with and without depressive personality disorder did not reach statistical significance. CONCLUSIONS: The present study, the first to determine the subsequent development of dysthymia and major depression in subjects with the sole diagnosis of depressive personality disorder, found that subjects with depressive personality disorder had a greater risk of developing dysthymia than did healthy comparison subjects at 3-year follow-up. Findings of the current study also suggest that depressive personality disorder may mediate the effects of a family history of axis I unipolar mood disorders.
>
> PMID: 11097962
>
>
> ----------------------------------------------------------
>
>
> 23: Am J Psychiatry 2000 Sep;157(9):1436-44
>
> Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: effects on personality.
>
> Hellerstein DJ, Kocsis JH, Chapman D, Stewart JW, Harrison W
>
> Outpatient Mental Health Services, Beth Israel Medical Center, New York, NY 10003, USA. dhellerstein@bethisraelny.org
>
> OBJECTIVE: Although previous studies have shown that dysthymia, or chronic depression, commonly responds to antidepressant medications (with improvements in depressive symptoms and psychosocial functioning), there have been no systematic studies of the impact of antidepressant treatment on personality variables in patients with this disorder. METHOD: In a multicenter study, 410 patients with early-onset primary dysthymia were treated in a randomized prospective fashion with sertraline, imipramine, or placebo. The data were analyzed in terms of the subjects' scores on the Tridimensional Personality Questionnaire, a 100-item self-report instrument that measures four temperamental dimensions: harm avoidance, reward dependence, novelty seeking, and persistence. RESULTS: At baseline, the harm avoidance scores of the dysthymic subjects were approximately 1.5 standard deviations higher than those of a previously reported community sample. After treatment, there was a significant decrease in harm avoidance scores, with no significant between-group differences. Remission of dysthymia was associated with significantly greater improvement in harm avoidance, with the greatest numerical change found in the patients treated with sertraline. Subjects' Tridimensional Personality Questionnaire scores were correlated at a 0.50 level with the Social Adjustment Scale both pre- and posttreatment, suggesting that a high degree of harm avoidance may be associated with poor social functioning. CONCLUSIONS: Before treatment, chronically depressed patients demonstrate an abnormality in temperament, as measured by elevated degrees of harm avoidance. Remission of dysthymia is associated with improvement in this aspect of temperament.
>
> Publication Types:
> Clinical trial
> Multicenter study
> Randomized controlled trial
>
> PMID: 10964860, UI: 20422057
>
>
> :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-) :-)
Posted by JohnL on December 4, 2000, at 4:47:19
In reply to Calling Dysthymics-My recent diagnosis-Help-Long , posted by shar on December 3, 2000, at 13:43:30
Shar,
Believe me, I know right down to the core exactly how you feel. Every emotion, confusion and frustration you're dealing with I have lived with every moment of every day for what seems like an eternity. The good news is that there is an answer. There is a drug(s) that will work. No ifs, and, or buts about it. One must grasp this truth with blind faith and set into motion an organized strategy to find what drug it might be.I too had a psychiatrist for a short while just like the one you just saw. Not very encouraging. It amazes me how some doctors can go through a decade of grueling study and dedication and yet end up displaying such impotence and lack of confidence at ending one's suffering.
Like most any psychiatric condition, dysthymia has a root cause. There is a chemical imbalance; or dysfunctional receptors that aren't working properly; or an electrical or chemical instability. A wide variety of underlying problems could cause your symptoms. The trick is to target that problem head-on. The trick is to find the drug that will do that, since we don't know in advance what the underlying problem is.
Of course it is more complicated than this, but basically one can categorize chemistry problems into groups. These include low serotonin, low or elevated noradrenaline, low or elevated dopamine, low GABA, noradrenaline/dopamiine failure (neuro levels are fine, but receptors aren't working right), chemical instability, and electrical instability. There are a handful of drugs appropriate for each chemistry.
To this point your treatment has primarily been restricted to neuro reputake inhibition of serotonin and/or NE and/or dopamine and GABA. This approach would work if the levels of these neuros were low. Since they aren't helping you much, there's a good chance the underlying problem doesn't have much to do with low neuro levels. There's probably something else going on. Though this is overly simplified, I think that when three drugs of similar mechanisms have failed, then it becomes a high priority to try drugs of different mechanisms.
What if it's a dopamine/NE/serotonin problem, and yet increasing their levels doesn't help? Then perhaps a different approach would include things like Zyprexa, Risperdal, Remeron, Amisulpride, which stimulate or modulate these neuros instead of preventing their reuptake. If it's chemical instability, Lithium. If it's electrical instability, then Depakote or Tegretol. If it's dopamine/NE failure, then Ritalin, Adderal, Adrafinil, or Modafinil.
It makes sense to try a couple drugs from each class. For example, try Zyprexa for a couple weeks, then Risperdal for a couple weeks. Try Ritalin for a week, then Adderall for a week. Lithium, Depakote, and Tegretol for about two weeks each. Clearly none of these will provide a total cure in that short time, but if one is to be a promising candidate for a longer trial it will likely give you some kind of hint within a couple weeks. When all is said and done, you can then return to the ones you liked for longer trials and tweeking.
The above process led me to Amisulpride+Adrafinil, which have nearly completely wiped out my longstanding dysthymia and anhedonia, which I had thought was untreatable (since I had failed so many more common drugs like SSRIs and Wellbutrin). So really, there is an answer, but one needs an organized 'probing' strategy to identify superior drugs for you. Obviously that will involve a doctor who is willing to do the same. If your doc says two weeks isn't long enough, say, "I know. I want to see what it can do in two weeks. If it's going to be good for me, I'll know fairly quickly. We have nothing to lose and everything to gain. Please cooperate with me on this." The whole process is to do two things: 1)treat all the different possible chemistry problems, knowing that with one of them we'll hit a bullseye; 2)find which drug in each class is preferred by your unique body and chemistry.
Hang in there. Someone once told me there are two ways to do things. One can work smart, or one can work hard. Develop a plan, a strategy, to probe different drugs and different chemistries. That's working smart. It increases the odds you will find a good drug in less than 6 months, versus the path you're on which will be a lot of work and may never yield a good drug ever.
Johnps...the drugs you are currently taking could confuse results. You might have to reduce or stop them so you can tell what a new drug is doing. I once tried Amisulpride and Adrafinil while I was also taking a normal dose of Prozac. The Prozac sort of numbed the good parts of the other drugs, so I couldn't really feel how well they were actually working. When I reduced Prozac, the other drugs began to shine through. It's hard to tell what a new drug will do if it is either drowned out or numbed by high doses of a current drug. If the current drugs aren't helping that much any way, I don't see much sense in continuing with them. If they help a little, then a reduced dosage could work just as well and sometimes even better (less numbing).
Posted by Noa on December 4, 2000, at 6:18:48
In reply to Re: Calling Dysthymics-My recent diagnosis-Help-Long » shar, posted by shellie on December 3, 2000, at 18:28:57
I agree with Shellie!
Posted by shar on December 5, 2000, at 9:53:15
In reply to Re: Calling Dysthymics-My recent diagnosis-Shar , posted by JohnL on December 4, 2000, at 4:47:19
Well, I was able to locate another really good dr. (supposed to be good, recommended by my therapist) and will try to see him for a third opinion. I feel much better "armed" going in with the information you all have shared and looking around the internet myself as well.
Thank you very, very much for the help and encouragement, and I will post updates here as I find anything out.
Shar
Posted by ksvt on December 5, 2000, at 21:15:53
In reply to Calling Dysthymics---Update, posted by shar on December 5, 2000, at 9:53:15
>Shar - for what it's worth I saw my pdoc today and told him of your diagnosis and prognosis. His opinion is that depressions take people through alot of different stages to the fact that yours has elements (as does mine he says) of dysthymia doesn't alter that you're really treating major depression. He also thought it outrageous that anyone would give you such a grim prognosis. Good luck with the new doc. ksvt
Well, I was able to locate another really good dr. (supposed to be good, recommended by my therapist) and will try to see him for a third opinion. I feel much better "armed" going in with the information you all have shared and looking around the internet myself as well.
>
> Thank you very, very much for the help and encouragement, and I will post updates here as I find anything out.
>
> Shar
Posted by JackD on December 5, 2000, at 22:03:49
In reply to Calling Dysthymics-My recent diagnosis-Help-Long , posted by shar on December 3, 2000, at 13:43:30
I hear you... all I can say is keep looking for an answer, keep searching for hope, and you WILL find help (But maybe not where you thought you would). Find a good therapist (Maybe one that's a little cheaper), and keep trying different drugs. If all else fails, try changing your lifestyle: try eating better, excercise, find new hobbies, meet new people, get away from major sources of depression in any way possible.
Have you ever tried stimulants like Ritalin or Adderall?
I think there are ways to get the Zoloft to work again too, although I'm not sure.
Oh, and if the zoloft worked so great, that means that there is something chemical that CAN be fixed. You should hold onto that as the key to your hope. There IS something that drugs can fix, and that is a GREAT, great thing to know.
Posted by AndrewB on December 6, 2000, at 10:24:57
In reply to Re: Calling Dysthymics-My recent diagnosis-Help-Long , posted by JackD on December 5, 2000, at 22:03:49
Shar,
Good move on getting an opinion from another doctor. That doctor you described in your first post seemed to neither appreciate the terrible loss dysthymia imposes on one's life or the potential for treating it.
Indeed dysthymia is very treatable. In the book, "Dysthymia and the Spectrum of Chronic Depressions" it was said that 70% of dysthymics showed improvement on medication. Dr. Akiskal claimed even greater results.
As has been pointed out above, MOA-Is are the standard treatment for (treatment resistant) dysthymia), and are generally quite effective. Being somewhat 'dirty' drugs though, they can have troublesome side effects.
There are other options, with less potential for side effects, that one might want to try first. Many people have, for example, found releif of their dysthymia with a low dose antipsychotic like amisulpride combined with an arousal agent.
However in your case, your initial good response to Zoloft, the following poop out, and the presence of major depression seems to call for a protocol different than that for treating just dysthymia.
I have been researching lately the implications of poop out to drugs like Zoloft lately and effective responses to such events (such as dopaminergic or NMDA receptor interventions). I hope in the near future I will be able to respond to a question such as yours with more specific suggestions.
AndrewB
Posted by AndrewB on December 6, 2000, at 11:09:24
In reply to Calling Dysthymics---Update, posted by shar on December 5, 2000, at 9:53:15
Shar,
Do a search under the key words 'poop out' in the Tips section (see top of page) for examples of standard treatments for poop out: thyroid meds (i.e. cytomel), switching to another serotenergic agent, addition of bromocriptine (I would suggest pramipexole instead), adding on naltrexone, or adding on a mood stabilizer (i.e. lithium). As adding on a mood stabilizer is most likely to cause side effects, maybe this alternative should be saved for last unless you have any symptoms of bipolar disorder or cyclothymia (i.e. periods of lethargy alternating with periods of increased energy).
AndrewB
Posted by MarkinBoston on December 6, 2000, at 15:47:57
In reply to Re: Dysthymics-My recent diagnosis-Help-Longer » shar, posted by SLS on December 3, 2000, at 20:30:21
I'm annoyed by these studies that make reference to social stress avoidance as a behavioral problem rather than a cortisol lowering adaptation.
I've read studies indicating 1/3 of people don't adapt to stress with lowering cortisol release in response to repeat stressor exposure.
Not much is made of estrogen levels in men and women and how it amplifies cortisol release in response to stress.
I failed to find any reasearch on a possible connection between a night person like me feeling more depressed in the morning when cortisol levels are highest.
Instead, these reasearchers with psyc mindsets see only behavioral problems, not behaviorial adaptations to physical problems.
Posted by Noa on December 6, 2000, at 19:07:19
In reply to Re: Calling Dysthymics---Update, posted by AndrewB on December 6, 2000, at 11:09:24
Nothing on adding a stimulant for augmentation? That is a pretty common one.
Posted by Noa on December 6, 2000, at 19:08:05
In reply to Re: Calling Dysthymics---Update, posted by AndrewB on December 6, 2000, at 11:09:24
PS--Andrew, sounds like you've done the ground work for a great folder at PBtips at eGroups.
Posted by Noa on December 6, 2000, at 19:14:41
In reply to Social avoidance - grrrr » SLS, posted by MarkinBoston on December 6, 2000, at 15:47:57
Interesting---I share your annoyance. This can be framed as a behavior problem, but also as a coping strategy. It is a problem to the extent it is detracting from one's life or causing distress, IMHO. I guess a behavioralist would call it a behavior problem. Problems of all kinds can be defined differently by focusihng on different aspects of it. Calling it a behavior problem is focusing on the social avoidance as the problem. The way you frame it focuses on the distress caused by stressful situations, like social exposure, as the problem. There are other ways to define this, too. I have a feeling that focusing on the avoidance as a behavior problem is counterproductive anyway for many people, because avoidance serves a purpose, perhaps not the most optimal method for that person, but a needed one for now until a better strategy comes along.
Posted by SLS on December 7, 2000, at 7:06:21
In reply to Re: Social avoidance - grrrr, posted by Noa on December 6, 2000, at 19:14:41
Hi guys.
I'm confused here. Which abstract are you referring to?Do you feel that "social avoidance" is the result of psychogenic pathology or of biogenic pathology". I am not sure which of these notions you are disagreeing with.
Are you saying that "social avoidance" is a behavioral adaptation to "stress avoidance"? What are some examples of these stressors and what are their origins?
I don't understand why you have interpreted any reference to a specific behavior described in the abstract as being of psychological origin or a "behavioral problem" without a biological counterpart or dependence.
I am not making an effort to defend the conclusions or inferences of the authors of these abstracts. I am just looking to learn something. I am having trouble seeing what you see.
When I read the abstracts, I understood the behaviors described as being an observed association found to be indicative of dysthymia, but without an explanation as to its origins. Nowhere did I see any reference to a psychological explanation to avoidant temperament or harm-avoidance behaviors. On the contrary,
"...suggesting that a high degree of harm avoidance may be associated with poor social functioning."
I don't see that "social" was ever used in the description of the "avoidance" they were describing and measuring. At best (at worst), they merely described another association. People can have a pathological need to avoid escalators and stairs, but without the need to avoid the people on them. I think this is the type of "harm avoidance" they speak of. Their contention is that when the dysthymia is successfully treated medically, these avoidant tendencies resolve as well. Certainly, avoidance of stairs and escalators would decrease social functioning.
Is the word "temperament" a problem? The word "temperament" is often used to describe a psychological or emotional substrate that contributes to phenotypic behaviors. Temperaments can be determined biologically or associated with biological illnesses. There is such a thing as a "bipolar" temperament associated with bipolar affective disorder. This temperament is often in place years before the first affective episode.
"CONCLUSIONS: Before treatment, chronically depressed patients demonstrate an abnormality in temperament, as measured by elevated degrees of harm avoidance. Remission of dysthymia is associated with improvement in this aspect of temperament"
That's all they were saying.
From context, I would say that it was a given that dysthymia was considered to be a biogenic condition. They were just curious to see what associated psychological, behavioral, and personality variables change when the dysthymia was brought into remission with antidepressants. It seems that dysthymia evolves some common psychosocial themes.
What am I missing? How does a cortisol reaction to stress or a stress reaction to cortisol fit in here?
- Scott
Posted by Noa on December 7, 2000, at 15:53:44
In reply to Re: Social avoidance - grrrr, posted by SLS on December 7, 2000, at 7:06:21
Hey, Scott.
I didn't read the abstracts, and wasn't reacting to them, I was reacting to the idea of calling the avoidance a "behavior problem"
When a researcher uses the word "temperament", I immediately surmise an assumption of some amount of biological basis. I don't know if I am right to do so, but that is one of the things the word "temperament" suggests to me. Probably from hearing about the famous Chess and Thomas studies on different temperaments of infants.
Anyway, you bring up some thoughtful questions. And I like that you made extra effort to present them in a way that would help it to be read as friendly questions.
Posted by shar on December 9, 2000, at 14:10:51
In reply to Calling Dysthymics-My recent diagnosis-Help-Long , posted by shar on December 3, 2000, at 13:43:30
My therapist gave me the name of a psychiatrist that is supposed to be very good on med issues, and I have an appointment for Jan. 12.
Hope (such as it is) springs eternal, I guess.
I'm printing out several of the responses to my original post to take with me and discuss with him.
Thanks again, ya'll,
Shar
Posted by Noa on December 11, 2000, at 7:18:10
In reply to Calling Dysthymics---Another Update, posted by shar on December 9, 2000, at 14:10:51
Shar, sometimes a fresh look at everything by a new person can really help, especially if it is by a pdoc with lots of experience with a variety of medications, symptoms, etc.
Good luck. Keep us posted.
Posted by KarenRB53 on June 26, 2006, at 13:18:24
In reply to Calling Dysthymics---Another Update, posted by shar on December 9, 2000, at 14:10:51
>Hi: Just wondering if you had an update on what meds you're taking the your dysthymic depression.
Thanks, Karen
My therapist gave me the name of a psychiatrist that is supposed to be very good on med issues, and I have an appointment for Jan. 12.
>
> Hope (such as it is) springs eternal, I guess.
>
> I'm printing out several of the responses to my original post to take with me and discuss with him.
>
> Thanks again, ya'll,
> Shar
This is the end of the thread.
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