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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 133. Go back in thread:
Posted by allisonm on March 7, 2001, at 15:48:00
In reply to treatment resistant depression, posted by sweetmarie on March 7, 2001, at 14:29:45
I have been diagnosed with chronic treatment resistant depression. I have tried Zoloft and Effexor XR but was not able to tolerate either. I was on Remeron for more than 2 years, then Remeron and lithium, then Remeron and Wellbutrin, then Wellbutrin and Remeron, then Wellbutrin and Neurontin, then Wellbutrin, Neurontin and Celexa. Am having to drop Celexa because I cannot stop shaking and it is causing sleep problems after more than a month. Next trial will be Wellbutrin, Neurontin (I think) and Serzone once I get off the Celexa. I haven't had as many years as you have trying drugs, but know exactly how you feel. With each new failure is the increasing feeling that I will never find the answer. I am surprised that your doctor(s) haven't tried Remeron and Effexor together before now, however, as this is known to be quite effective. There is an eGroups page on Remeron that will have references to its use with Effexor. Good luck.
Posted by Jeff on March 7, 2001, at 16:32:35
In reply to Re: treatment resistant depression, posted by allisonm on March 7, 2001, at 15:48:00
You have probablyheard about the study showing great success with prozac+zyprexa as well.
> I have been diagnosed with chronic treatment resistant depression. I have tried Zoloft and Effexor XR but was not able to tolerate either. I was on Remeron for more than 2 years, then Remeron and lithium, then Remeron and Wellbutrin, then Wellbutrin and Remeron, then Wellbutrin and Neurontin, then Wellbutrin, Neurontin and Celexa. Am having to drop Celexa because I cannot stop shaking and it is causing sleep problems after more than a month. Next trial will be Wellbutrin, Neurontin (I think) and Serzone once I get off the Celexa. I haven't had as many years as you have trying drugs, but know exactly how you feel. With each new failure is the increasing feeling that I will never find the answer. I am surprised that your doctor(s) haven't tried Remeron and Effexor together before now, however, as this is known to be quite effective. There is an eGroups page on Remeron that will have references to its use with Effexor. Good luck.
Posted by sweetmarie on March 7, 2001, at 16:40:58
In reply to Re: treatment resistant depression, posted by allisonm on March 7, 2001, at 15:48:00
> I have been diagnosed with chronic treatment resistant depression. I have tried Zoloft and Effexor XR but was not able to tolerate either. I was on Remeron for more than 2 years, then Remeron and lithium, then Remeron and Wellbutrin, then Wellbutrin and Remeron, then Wellbutrin and Neurontin, then Wellbutrin, Neurontin and Celexa. Am having to drop Celexa because I cannot stop shaking and it is causing sleep problems after more than a month. Next trial will be Wellbutrin, Neurontin (I think) and Serzone once I get off the Celexa. I haven't had as many years as you have trying drugs, but know exactly how you feel. With each new failure is the increasing feeling that I will never find the answer. I am surprised that your doctor(s) haven't tried Remeron and Effexor together before now, however, as this is known to be quite effective. There is an eGroups page on Remeron that will have references to its use with Effexor. Good luck.
I feel reassured that I am not the only one having difficulties with medication treatment. The specialist I was referred to intends to try a combination of Venlafaxine, Mirtazapine and wants me to remain on the Lamotragine but at a (much) higher dose. To do this he wants me to be an in-patient at his hospital in Newcastle (about 150 miles away from where I live) because it will both speed the transition up, and be a support as coming off Phenelzine is notoriously difficult - I am likely to be quite ill (i.e. even more depressed). I am glad to be coming off the Phenelzine, as it has made me gain 3 stone. However, apparently the Mirtazapine that I am going onto has weight gain as a possible side effect. Obviously, if the treatment `works` then I won`t mind so much being overweight, but it doesn`t do my self-esteem any favours at the moment. As for Remeron, I could be wrong but I have a feeling that it is the trade name for Mirtazapine in the States (it`s Zispin over here). Anyway, I`ll have to wait and see. I do agree though that it`s very easy to get into a real `spiral` of depair when nothing seems to work (even when assured by all sides that there is `something for everyone`). I hate to admit it, but I find myself resenting those who seem to `take to` anti-depressants with such success, although I realise that this is not a fair way to see things.
Thanks for replying - keep me updated (if you want). Good luck to you, too.
Posted by allisonm on March 7, 2001, at 18:36:50
In reply to Re: treatment resistant depression » allisonm, posted by sweetmarie on March 7, 2001, at 16:40:58
Yes, Remeron is the brand name for mirtaziapine. I gained weight on it. I lost the weight with Wellbutrin, though.
You might read the eGroups page or do an archive search on Remeron. In any case, do not be surprised if it hits you like a brick and you sleep for a long time. This will wear off for most people as you become adjusted.
Do keep in touch. I visit this board regularly.
Posted by phillybob on March 7, 2001, at 23:14:02
In reply to treatment resistant depression, posted by sweetmarie on March 7, 2001, at 14:29:45
http://www.dr-bob.org/babble/20001231/msgs/51384.html
I linked and cut and pasted an interesting and relevant (to this discussion) article in this discussion thread on topamax experiences.
Posted by JohnL on March 8, 2001, at 17:35:42
In reply to treatment resistant depression, posted by sweetmarie on March 7, 2001, at 14:29:45
I sound like a broken record because I say this so often, but as I see it there are a small handful of drugs that could prove very helpful to you. None of them have yet been tried. The only reason I suggest these drugs is because they have proven to be helpful to quite a few folks here that have had trouble with more straight forward treatments. Including me.
The broken record drugs I'm referring to are Zyprexa, Amisulpride, Adrafinil, Risperdal, or any combination of two of them (not Zyprexa+Risperdal together though). Any of them, or any combination of them, seem to work especially well with a little bit of an SSRI in the background.
The drugs you are on or have tried are far more harsh than any of these drugs I've mentioned. Since you can handle the side effects of the other drugs, then the ones I mentioned will seem like candy. Except for one thing. They will probably work.
There are various theories as to what causes depression. The most popular one is a deficiency in neurotransmitters. Increasing them is what antidepressants do. You have pretty much exhausted that theory in your case. Time to explore other ones. That's where the drugs I mentioned come into play.
John
Posted by Shar on March 8, 2001, at 19:22:48
In reply to Re: treatment resistant depression, posted by JohnL on March 8, 2001, at 17:35:42
My pdoc recently added .5 mg Risperdal to my cocktail of wellbutrin and effexor, and klnonpin at night. It worked (I felt relief from depression) within a few days. We upped it to .75 because I was having the "feeling ok then the bottom falls out" plus "rage reactions" and doc said increase could help me stay feeling better for 24 hours, plus rage reaction could be a rx to withdrawal when .50 couldn't get me thru 24 hours.
BTW, I have not felt this good in years. Years! It is incredible. Zoloft also worked well for me, but pooped out. I am praying this will not poop out.
Shar
> I sound like a broken record because I say this so often, but as I see it there are a small handful of drugs that could prove very helpful to you. None of them have yet been tried. The only reason I suggest these drugs is because they have proven to be helpful to quite a few folks here that have had trouble with more straight forward treatments. Including me.
>
> The broken record drugs I'm referring to are Zyprexa, Amisulpride, Adrafinil, Risperdal, or any combination of two of them (not Zyprexa+Risperdal together though). Any of them, or any combination of them, seem to work especially well with a little bit of an SSRI in the background.
>
> The drugs you are on or have tried are far more harsh than any of these drugs I've mentioned. Since you can handle the side effects of the other drugs, then the ones I mentioned will seem like candy. Except for one thing. They will probably work.
>
> There are various theories as to what causes depression. The most popular one is a deficiency in neurotransmitters. Increasing them is what antidepressants do. You have pretty much exhausted that theory in your case. Time to explore other ones. That's where the drugs I mentioned come into play.
> John
Posted by sweetmarie on March 9, 2001, at 7:26:57
In reply to Re: treatment resistant depression--ditto » JohnL, posted by Shar on March 8, 2001, at 19:22:48
> My pdoc recently added .5 mg Risperdal to my cocktail of wellbutrin and effexor, and klnonpin at night. It worked (I felt relief from depression) within a few days. We upped it to .75 because I was having the "feeling ok then the bottom falls out" plus "rage reactions" and doc said increase could help me stay feeling better for 24 hours, plus rage reaction could be a rx to withdrawal when .50 couldn't get me thru 24 hours.
>
> BTW, I have not felt this good in years. Years! It is incredible. Zoloft also worked well for me, but pooped out. I am praying this will not poop out.
>
> Shar
>
>
>
>
> > I sound like a broken record because I say this so often, but as I see it there are a small handful of drugs that could prove very helpful to you. None of them have yet been tried. The only reason I suggest these drugs is because they have proven to be helpful to quite a few folks here that have had trouble with more straight forward treatments. Including me.
> >
> > The broken record drugs I'm referring to are Zyprexa, Amisulpride, Adrafinil, Risperdal, or any combination of two of them (not Zyprexa+Risperdal together though). Any of them, or any combination of them, seem to work especially well with a little bit of an SSRI in the background.
> >
> > The drugs you are on or have tried are far more harsh than any of these drugs I've mentioned. Since you can handle the side effects of the other drugs, then the ones I mentioned will seem like candy. Except for one thing. They will probably work.
> >
> > There are various theories as to what causes depression. The most popular one is a deficiency in neurotransmitters. Increasing them is what antidepressants do. You have pretty much exhausted that theory in your case. Time to explore other ones. That's where the drugs I mentioned come into play.
> > JohnYou are right I haven`t tried any of the drugs you mentioned (unless of course they go by different names here in the UK, but I didn`t recognise any of them). As I said in an earlier posting, this specialist whose care I will be under when I go for treatment at the hospital he works from, is trying me on Venlafaxine, Mirtazapine and Lamotragine (which I am already on, but he is `upping` the dose quite considerably from 25 mg to 250 mg). I am to be staying in hospital until `better`, in other words, it is an open-ended stay. What I imagine he`ll do is explore other options after this intial treatment - if it doesn`t work, and obviously I sincerely hope it does. I don`t know how much input I will be given in my treatment; my consultant encouraged me to be involved, and I found out about medications for myself, which we then tried. However, as an expert, I doubt if he will welcome the same involvement. One thing that I haven`t mentioned is that when I first sought medical help (11 years ago now), I was given Dothiepin. This worked almost 100%, and I couldn`t believe the quality of life it gave me - I hadn`t EVER felt like that. I discontinued the drug after a year, and the symptoms immediately recurred, so I went back onto it. This time, though, it did absolutely nothing at all, despite persisting for about 18 months at every dosage. I don`t know really why I mention this, but it has always struck me as odd and extremely frustrating, i.e. I wish I`d stayed on it. It`s just a `wait and see` situation again, but I guess that being in a unit that actually specialises in `difficult to treat` depression will mean that I am in the right place.
Posted by jrw on March 9, 2001, at 11:13:34
In reply to Re: treatment resistant depression--ditto » Shar, posted by sweetmarie on March 9, 2001, at 7:26:57
Marie,
Sounds like you are doing the right thing, and
going to the right place. I hope it helps. I know
how frustrating it is when a drug that once
helped a lot no longer does...last fall, I had a
couple of strange days when Prozac, which had
once helped some, made me actually feel good for a
couple of days. It was amazing. I was thinking,
'Is this how other people usually feel?'I wish you the very best and am pulling for you.
J
> > My pdoc recently added .5 mg Risperdal to my cocktail of wellbutrin and effexor, and klnonpin at night. It worked (I felt relief from depression) within a few days. We upped it to .75 because I was having the "feeling ok then the bottom falls out" plus "rage reactions" and doc said increase could help me stay feeling better for 24 hours, plus rage reaction could be a rx to withdrawal when .50 couldn't get me thru 24 hours.
> >
> > BTW, I have not felt this good in years. Years! It is incredible. Zoloft also worked well for me, but pooped out. I am praying this will not poop out.
> >
> > Shar
> >
> >
> >
> >
> > > I sound like a broken record because I say this so often, but as I see it there are a small handful of drugs that could prove very helpful to you. None of them have yet been tried. The only reason I suggest these drugs is because they have proven to be helpful to quite a few folks here that have had trouble with more straight forward treatments. Including me.
> > >
> > > The broken record drugs I'm referring to are Zyprexa, Amisulpride, Adrafinil, Risperdal, or any combination of two of them (not Zyprexa+Risperdal together though). Any of them, or any combination of them, seem to work especially well with a little bit of an SSRI in the background.
> > >
> > > The drugs you are on or have tried are far more harsh than any of these drugs I've mentioned. Since you can handle the side effects of the other drugs, then the ones I mentioned will seem like candy. Except for one thing. They will probably work.
> > >
> > > There are various theories as to what causes depression. The most popular one is a deficiency in neurotransmitters. Increasing them is what antidepressants do. You have pretty much exhausted that theory in your case. Time to explore other ones. That's where the drugs I mentioned come into play.
> > > John
>
> You are right I haven`t tried any of the drugs you mentioned (unless of course they go by different names here in the UK, but I didn`t recognise any of them). As I said in an earlier posting, this specialist whose care I will be under when I go for treatment at the hospital he works from, is trying me on Venlafaxine, Mirtazapine and Lamotragine (which I am already on, but he is `upping` the dose quite considerably from 25 mg to 250 mg). I am to be staying in hospital until `better`, in other words, it is an open-ended stay. What I imagine he`ll do is explore other options after this intial treatment - if it doesn`t work, and obviously I sincerely hope it does. I don`t know how much input I will be given in my treatment; my consultant encouraged me to be involved, and I found out about medications for myself, which we then tried. However, as an expert, I doubt if he will welcome the same involvement. One thing that I haven`t mentioned is that when I first sought medical help (11 years ago now), I was given Dothiepin. This worked almost 100%, and I couldn`t believe the quality of life it gave me - I hadn`t EVER felt like that. I discontinued the drug after a year, and the symptoms immediately recurred, so I went back onto it. This time, though, it did absolutely nothing at all, despite persisting for about 18 months at every dosage. I don`t know really why I mention this, but it has always struck me as odd and extremely frustrating, i.e. I wish I`d stayed on it. It`s just a `wait and see` situation again, but I guess that being in a unit that actually specialises in `difficult to treat` depression will mean that I am in the right place.
Posted by JahL on March 9, 2001, at 13:03:13
In reply to treatment resistant depression, posted by sweetmarie on March 7, 2001, at 14:29:45
> I suffer from (severe chronic `double`) depression, which has proved VERY difficult to treat (I`ve had Tricyclics, SSRIs, an MAOI (Nardil), ECT, Maclobomide, Reboxetine, L-Tryptophan, Venlafaxine, and different permutations. I am currently on Nardil, Trimipramine, Lamotragine and Epilim to no effect). I`ve been referred to a specialist in `difficult to treat depression`, who plans to put me onto Venlafaxine, Mirtazapine and increase the dose of Lamotragine. I don`t really know why I am posting this message; I guess that I was wondering whether anyone else out there has had similar difficulties (I have been going through a major depressive episode for the past 6/7 years now, which has been severe over the past 3. Has anyone `been` where I am now? Any success stories? Or even partial success stories? I am very ill at the minute, and feel extremely hopeless - something which grows more with every treatment failure. I have had different kinds of `talking` therapy over the past 9 years, and hope to be well enough at some stage to do CBT. Can anyone help?
Hi there.
Like yourself I'm UK with treatment-resistant double depression (+ADD+social phobia...). I've had high-dose trials of all the meds you mention, & many more besides. All w/out significant success...that was until I started Lamotrigine just over 2 wks ago. I'm only just up to 37.5mg but already the improvement has been dramatic (see 'BIPOLAR EXPERT' thread 4 details).At yr current 25mg dose I can almost *guarantee* (tho' definitely no expert) you won't feel significant remission of yr depression. The proposed 250mg will give Lamotrigine scope to work it's magic (I'm biased).
You are fortunate to have found such a forward-thinking UK pdoc-I can't even find one to prescribe Lamotr. monotherapy, let alone such 'power combos'. I have to order mine from abroad (tut,tut,eh steve?). It's just a shame you have to reside in hospital.
I have high hopes for the Lamotrigine (which has the most anti-depressive profile of the mood-stabilizers); you may even find the Venlafaxine+Mirtazapine become/are redundant! Your doc sounds like he knows what he's doing.
Good Luck,
Jah.
Posted by steve on March 9, 2001, at 15:33:03
In reply to Re: treatment resistant depression » sweetmarie, posted by JahL on March 9, 2001, at 13:03:13
Are you a melancholic depressive (ie no appetite, no sleep and agitation) or an atypical one (ie sleeping all the time, overeating and feeling just tired.)
If you are the former, meds like nardil etc could very well be making things worse and not better.
The two different forms of depression have opposite symptoms and functional imaging studies have shown that in one form of depression some areas are underactivated and in the other one the same areas are overactivated.
This begs the question how the same medicine is good for both manifestations. The answer is that meds seem to cause structural changes to the brain that usually allow melancholics to lead a normal life, and at the same time cause other changes which give atypicals their oomph.
However, and I think this a terrible blot on psychiatry, which I consider the most corrupted part of medicine, some can't handle the energizing properties of the SSRIs, and actually do worse on them, as my Yale educated doctor told me. Dr. Cole at Harvard estimates that roughly one out of every two hundred depressives becomes severely agitated on the SSRIs, and I would wager that there are even more people who don't go nuts, but become more depressed on them. And of course most idiot shrinks, going purely by what they learn at the symposia sponsored by pharma companies, conclude that their patients are doing worse despite, and not because of, their medicines. This in turn leads them to add more medicines, making the sitation even worse. According to my doc, the best one can do for melancholics who worsen on ssris is to take them off SSRIs and go with lamotrigine monotherapy.
Since I've just once again harped on how corrupted psychiatry has become, maybe I should give an example. When their were concerns that Prozac, which is known for giving tired depressives a "boost" might be making agitateted depressives even more anxious, perhaps to the point of becoming psychotic, Eli Lilly hired Dr. Martin Keller to 'study' the matter. Later on it emerged that Lilly and others had paid Keller $500,000 without it being reported. I think justice would have required that he be stripped of his professorship at the very least, and his medical license probably as well. Instead the only repercussion of his blatantly unethical conduct was that he was barred from giving presentations at the APA. Another barely known factoid is that the FDA seriously considered making Lilly include a warning in its Prozac information leaflet saying that Prozac had been found to worsen many forms of depression. For reasons that are somewhat opaque to me, they decided that such a warning would be too 'complicated.' Face it sports fans, the only focus of the industry is to sell their product. If it gets you well that's good, if not, or it worsens your condition, that's your problem.
> > I suffer from (severe chronic `double`) depression, which has proved VERY difficult to treat (I`ve had Tricyclics, SSRIs, an MAOI (Nardil), ECT, Maclobomide, Reboxetine, L-Tryptophan, Venlafaxine, and different permutations. I am currently on Nardil, Trimipramine, Lamotragine and Epilim to no effect). I`ve been referred to a specialist in `difficult to treat depression`, who plans to put me onto Venlafaxine, Mirtazapine and increase the dose of Lamotragine. I don`t really know why I am posting this message; I guess that I was wondering whether anyone else out there has had similar difficulties (I have been going through a major depressive episode for the past 6/7 years now, which has been severe over the past 3. Has anyone `been` where I am now? Any success stories? Or even partial success stories? I am very ill at the minute, and feel extremely hopeless - something which grows more with every treatment failure. I have had different kinds of `talking` therapy over the past 9 years, and hope to be well enough at some stage to do CBT. Can anyone help?
>
> Hi there.
> Like yourself I'm UK with treatment-resistant double depression (+ADD+social phobia...). I've had high-dose trials of all the meds you mention, & many more besides. All w/out significant success...that was until I started Lamotrigine just over 2 wks ago. I'm only just up to 37.5mg but already the improvement has been dramatic (see 'BIPOLAR EXPERT' thread 4 details).
>
> At yr current 25mg dose I can almost *guarantee* (tho' definitely no expert) you won't feel significant remission of yr depression. The proposed 250mg will give Lamotrigine scope to work it's magic (I'm biased).
>
> You are fortunate to have found such a forward-thinking UK pdoc-I can't even find one to prescribe Lamotr. monotherapy, let alone such 'power combos'. I have to order mine from abroad (tut,tut,eh steve?). It's just a shame you have to reside in hospital.
>
> I have high hopes for the Lamotrigine (which has the most anti-depressive profile of the mood-stabilizers); you may even find the Venlafaxine+Mirtazapine become/are redundant! Your doc sounds like he knows what he's doing.
>
> Good Luck,
> Jah.
Posted by JahL on March 9, 2001, at 16:56:55
In reply to Re: treatment resistant (or caused) depression » JahL, posted by steve on March 9, 2001, at 15:33:03
> > Are you a melancholic depressive (ie no appetite, no sleep and agitation) or an atypical one (ie sleeping all the time, overeating and feeling just tired.)
> > If you are the former, meds like nardil etc could very well be making things worse and not better.
> > The two different forms of depression have opposite symptoms and functional imaging studies have shown that in one form of depression some areas are underactivated and in the other one the same areas are overactivated.
> > This begs the question how the same medicine is good for both manifestations. The answer is that meds seem to cause structural changes to the brain that usually allow melancholics to lead a normal life, and at the same time cause other changes which give atypicals their oomph.
> > However, and I think this a terrible blot on psychiatry, which I consider the most corrupted part of medicine, some can't handle the energizing properties of the SSRIs, and actually do worse on them, as my Yale educated doctor told me. Dr. Cole at Harvard estimates that roughly one out of every two hundred depressives becomes severely agitated on the SSRIs, and I would wager that there are even more people who don't go nuts, but become more depressed on them. And of course most idiot shrinks, going purely by what they learn at the symposia sponsored by pharma companies, conclude that their patients are doing worse despite, and not because of, their medicines. This in turn leads them to add more medicines, making the sitation even worse. According to my doc, the best one can do for melancholics who worsen on ssris is to take them off SSRIs and go with lamotrigine monotherapy.Steve. On this one I am COMPLETELY in agreement with you (makes a change, huh?). I fit yr description of 'melancholic depressive' and found that the SSRIs, Nardil etc did indeed worsen my depression (pdocs insisted that ADs *couldn't* exacerbate depression-how ignorant can you get? Can you see why I've practically given up on them?), specifically by making me more agitated.
As your pdoc predicts, Lamotrigine has been by far the best drug so far & it's still early days.
Jah.
> >Since I've just once again harped on how corrupted psychiatry has become, maybe I should give an example. When their were concerns that Prozac, which is known for giving tired depressives a "boost" might be making agitateted depressives even more anxious, perhaps to the point of becoming psychotic, Eli Lilly hired Dr. Martin Keller to 'study' the matter. Later on it emerged that Lilly and others had paid Keller $500,000 without it being reported. I think justice would have required that he be stripped of his professorship at the very least, and his medical license probably as well. Instead the only repercussion of his blatantly unethical conduct was that he was barred from giving presentations at the APA. Another barely known factoid is that the FDA seriously considered making Lilly include a warning in its Prozac information leaflet saying that Prozac had been found to worsen many forms of depression. For reasons that are somewhat opaque to me, they decided that such a warning would be too 'complicated.' Face it sports fans, the only focus of the industry is to sell their product. If it gets you well that's good, if not, or it worsens your condition, that's your problem.
>
Posted by sweetmarie on March 9, 2001, at 17:32:20
In reply to Re: treatment resistant depression, posted by JohnL on March 8, 2001, at 17:35:42
> I sound like a broken record because I say this so often, but as I see it there are a small handful of drugs that could prove very helpful to you. None of them have yet been tried. The only reason I suggest these drugs is because they have proven to be helpful to quite a few folks here that have had trouble with more straight forward treatments. Including me.
>
> The broken record drugs I'm referring to are Zyprexa, Amisulpride, Adrafinil, Risperdal, or any combination of two of them (not Zyprexa+Risperdal together though). Any of them, or any combination of them, seem to work especially well with a little bit of an SSRI in the background.
>
> The drugs you are on or have tried are far more harsh than any of these drugs I've mentioned. Since you can handle the side effects of the other drugs, then the ones I mentioned will seem like candy. Except for one thing. They will probably work.
>
> There are various theories as to what causes depression. The most popular one is a deficiency in neurotransmitters. Increasing them is what antidepressants do. You have pretty much exhausted that theory in your case. Time to explore other ones. That's where the drugs I mentioned come into play.
> JohnI would like to really thank all that have replied to my post. It certainly seems that I am NOT the freak I thought I was. I am encouraged by what I have heard re. Lamotragine (although I have developed quite a noticeable rash on my arms, which is stated as a possible side effect of this medication, so I`m assuming that the Lamotragine is the cause; I`m not sure what to do about this - any ideas? has anyone else experienced this?). Anyway, I`ll have to wait and see ...
Posted by NikkiT2 on March 9, 2001, at 17:48:20
In reply to Re: treatment resistant depression, posted by JohnL on March 8, 2001, at 17:35:42
John,
you have to be hospitlised in the UK to get combo therapy!!! useless I know, but suggesting combos to us Brits is a waste of time, as our "wonderful" pdocs won't prescribe them!!!
Nikki
Posted by phillybob on March 9, 2001, at 18:20:32
In reply to Re: treatment resistant depression, posted by sweetmarie on March 9, 2001, at 17:32:20
< < I have developed quite a noticeable rash on my arms, which is stated as a possible side effect of this medication, so I`m assuming that the Lamotragine is the cause; I`m not sure what to do about this - any ideas?
Sweetmarie, you are an in-patient correct? The staff at the facility are aware of such, I presume? If not, notify them. From what I understand, though have not experienced this, it can be a very bad thing, so it needs to be monitored most definitely by experts.
You had said that you are "upping the dose [Lamotragine] quite considerably from 25 mg to 250 mg)." How quickly did you move up and from what dosage to what dosage? That could be the culprit, again, from what I've heard.
Others on here can likely give more input. Best wishes.
Posted by sweetmarie on March 9, 2001, at 19:29:50
In reply to Re: treatment resistant depression sweetmarie, posted by phillybob on March 9, 2001, at 18:20:32
> < < I have developed quite a noticeable rash on my arms, which is stated as a possible side effect of this medication, so I`m assuming that the Lamotragine is the cause; I`m not sure what to do about this - any ideas?
>
> Sweetmarie, you are an in-patient correct? The staff at the facility are aware of such, I presume? If not, notify them. From what I understand, though have not experienced this, it can be a very bad thing, so it needs to be monitored most definitely by experts.
>
> You had said that you are "upping the dose [Lamotragine] quite considerably from 25 mg to 250 mg)." How quickly did you move up and from what dosage to what dosage? That could be the culprit, again, from what I've heard.
>
> Others on here can likely give more input. Best wishes.Phillybob - no I`m not an in-patient yet. What`s happening is that I am moving away from Leeds (where I live), to another hospital about 100 miles away. This hospital is where the specialist I saw works from, and whilst I`m there, I`ll be under his care whilst remaining under my usual psychiatrist`s care (if you see what I mean). I saw my GP about the rash a few times, and was prescribed various things (anti-biotics, skin wash, and a cream), none of which worked. I then saw a dermatologist ho told me it was some kind of follicle thing (she gave me a name for it, but I`ve forgotten). She was actually quite dismissive, and didn`t make any connection between the rash and the medication (Lamotragine, as I think I`ve mentioned). Finally I mentioned it to my psychiatrist who said that it was very likely to be the result of the medication, and that whn I was feeling `well`, it wouldn`t bother me so much. It doesn`t actually bother me in terms of physical discomfort, but I`m very aware of it and always keep my arms covered up. This upsets me, because I feel `unsightly` because of it. My intention is to point it out to the staff at the hospital in hopes that they can suggest something I can do about it. It`s certainly a bummer, and one I could very well do without; I`ve also put on weight with my current medication (Nardil), which will I will hopefully lose when I come off it (I am reducing at the moment, in preparation for going onto the new combination). However, the 2 together (rash and weight gain) don`t do my self-image any favours. Maybe I`m being vain, but it does really bother me. Anyway, thanks for replying; hopefully I can get in seen to properly whilst I am in hospital. Cheers.
Posted by phillybob on March 9, 2001, at 19:53:59
In reply to Re: treatment resistant depression sweetmarie, posted by sweetmarie on March 9, 2001, at 19:29:50
Okay, sweetmarie, I did not want to alarm you but I thought you were in a hospital setting. Please read the following quote from Dr. Ivan Goldberg's depression central ( http://www.psycom.net/depression.central.lamotrigine.html ):
"14. Which side-effects are severe enough to force people to discontinue lamotrigine?
The side-effect of lamotrigine that most often causes the drug to be discontinued is a rash. Rashes can be mild, similar to a slight sunburn, or can be quite severe resembling a severe case of poison-ivy. The more severe the rash the less likely it is that the individual will be able to continue the medication. ALL rashes should be reported to the physicians prescribing the lamotrigine.
A rash is more likely to develop when the initial doses of lamotrigine are high or when lamotrigine is too rapidly started when someone is taking valproate.
It is important that people taking lamotrigine who develop a rash immediately contact their physician as there have been a few deaths in people who have developed lamotrigine-induced rashes."
I think the name of the deadly rash problem is Steven-Johnson's Syndrome. It does not seem that your prescribing doc is aware of this? How much of an increase in dosage has he/she prescribed for you?
Again, best wishes.
Posted by JahL on March 9, 2001, at 19:59:34
In reply to Re: treatment resistant depression, posted by sweetmarie on March 9, 2001, at 17:32:20
> I would like to really thank all that have replied to my post. It certainly seems that I am NOT the freak I thought I was. I am encouraged by what I have heard re. Lamotragine (although I have developed quite a noticeable rash on my arms, which is stated as a possible side effect of this medication, so I`m assuming that the Lamotragine is the cause; I`m not sure what to do about this - any ideas? has anyone else experienced this?). Anyway, I`ll have to wait and see ...Like phillybob says, the rash is cause for concern. The Lamotrigine PDF says to discontinue Lamot. immediately upon appearance of a rash. CamW, Sunnely et al can better explain, but there are potenially serious implications here, not least of which is the the potentially fatal Stevens-Johnson (sp?) Syndrome. The PDF warns that rashes *could* result in permanent skin blemishes.
Don't freak out, but keep an eye on the rash & speak to someone knowlegable about Lamotrigine specifically ASAP. Plenty of people have continued to take Lamot. only for the rash 2 disappear w/o trace, but you *must* get it checked out (IMO).
Good Luck,
J.
Posted by steve on March 9, 2001, at 21:52:50
In reply to Re: treatment resistant depression » steve, posted by JahL on March 9, 2001, at 16:56:55
The sad thing is that there are credible epidemiological estimates putting the number of deaths due to ssri activation at roughly 50,000. Atypicals rarely if ever kill themselves, but melancholics do, particularly when overstimulated.
As for finding competent doctors, in my experience that has been pretty hard. If you want a good critique of the dangers and untold side-effects of psychotropics, www.skepticalpsych.com or Breggin's "Your med might be your problem" are great places to start reading. I don't agree with their absolute hostility to bio psychiatry, which isn't factual, but reading about all the shenanigans, ignorance and outright lies made by paid for researchers certainly was an eye-opener.
S.
> Steve. On this one I am COMPLETELY in agreement with you (makes a change, huh?). I fit yr description of 'melancholic depressive' and found that the SSRIs, Nardil etc did indeed worsen my depression (pdocs insisted that ADs *couldn't* exacerbate depression-how ignorant can you get? Can you see why I've practically given up on them?), specifically by making me more agitated.
>
> As your pdoc predicts, Lamotrigine has been by far the best drug so far & it's still early days.
>
> Jah.
>
Posted by sweetmarie on March 10, 2001, at 6:22:05
In reply to Re: treatment resistant depression » sweetmarie, posted by phillybob on March 9, 2001, at 19:53:59
> Okay, sweetmarie, I did not want to alarm you but I thought you were in a hospital setting. Please read the following quote from Dr. Ivan Goldberg's depression central ( http://www.psycom.net/depression.central.lamotrigine.html ):
>
> "14. Which side-effects are severe enough to force people to discontinue lamotrigine?
>
> The side-effect of lamotrigine that most often causes the drug to be discontinued is a rash. Rashes can be mild, similar to a slight sunburn, or can be quite severe resembling a severe case of poison-ivy. The more severe the rash the less likely it is that the individual will be able to continue the medication. ALL rashes should be reported to the physicians prescribing the lamotrigine.
>
> A rash is more likely to develop when the initial doses of lamotrigine are high or when lamotrigine is too rapidly started when someone is taking valproate.
>
> It is important that people taking lamotrigine who develop a rash immediately contact their physician as there have been a few deaths in people who have developed lamotrigine-induced rashes."
>
> I think the name of the deadly rash problem is Steven-Johnson's Syndrome. It does not seem that your prescribing doc is aware of this? How much of an increase in dosage has he/she prescribed for you?
>
> Again, best wishes.The rash is similar to a `dry skin rash`, of the kind I have always had on my upper arms, except now it`s got worse and is more noticeable. It`s interesting that you make the Vaproate connection, as I am also taking this. However, I am coming off this - slowly decreasing the dosage until I come off altogether. Possibly this will help. I will certainly point the rash out to the psych doctors when I go into hospital (if it`s still there).
sweetmarie
Posted by phillybob on March 10, 2001, at 10:37:37
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on March 10, 2001, at 6:22:05
< I will certainly point the rash out to the psych doctors when I go into hospital (if it`s still there). >
If you are NOT going into the hospital today or tomorrow, please inform a professional of your rash as it can lead to most unfortunate consequences (even death).
Also, to help us (those, like myself, beginning lamictal therapy) understand what factors may have contributed to causing the rash:
(1) How much of lamotrigine are you taking and what was the rate of increase in dosage?
and, (2) How much valproate have you been taking along with the lamotrigine?
Thanks for your input, sweetmarie, and I hope your rash ends up being nothing bad after all.
Posted by sweetmarie on March 10, 2001, at 13:13:55
In reply to Re: treatment resistant depression , posted by phillybob on March 10, 2001, at 10:37:37
> < I will certainly point the rash out to the psych doctors when I go into hospital (if it`s still there). >
>
> If you are NOT going into the hospital today or tomorrow, please inform a professional of your rash as it can lead to most unfortunate consequences (even death).
>
> Also, to help us (those, like myself, beginning lamictal therapy) understand what factors may have contributed to causing the rash:
>
> (1) How much of lamotrigine are you taking and what was the rate of increase in dosage?
>
> and, (2) How much valproate have you been taking along with the lamotrigine?
>
> Thanks for your input, sweetmarie, and I hope your rash ends up being nothing bad after all.Phillybob, over the past year I have been taking 25 mg of Lamotragine plus 1000 mg of Valproate. My psychiatrist - on instruction from the specialist I saw (and will subsequently be `under` during my hospital stay) put the dosage up from this (25 mg) to 100 mg, with the aim of increasing it to 250 mg. I was taking the 100 mg for a week and went up to 200 mg 2 days ago. I will then increase to 250 mg in another week. Having written it down, it seems like quite a `steep` increase. I`m not sure whether this is a good or a bad thing - I guess it must be O.K. otherwise my psychiatrist wouldn`t have done it. I`m not due to go into hospital for about another 5 weeks, but as I said before, my psychiatrist didn`t seem to think that the rash was anything to worry about. Neither did the dermatologist - mind you, I was in and out of that appointment within about 5 minutes, so I don`t know whether she made the connection (although I did tell her which medications I was taking). The rash itself is basically little spots, kind of like normal spots only smaller. They mostly have `heads` on them (sorry for being a bit graphic here). Having said all of this, my psychiatrist had only put one other patient on Lamotragine (a woman who had `discovered` it on the Net). Prior to this, she hadn`t heard of the drug. I`m not actually sure of what to do about all this; I feel like I have exhausted all my options (psychiatrist, GP, and dermatologist). What I may do, is post a question to one of the on-line psychiatric `experts`, and see what they say.
I guess that this isn`t very helpful (though at least I was able to give you dosages). I can`t remember whether I mentioned this, but as I am increasing the Lamotragine, I am phasing out the Valproate altogether. This may make a difference - I don`t know.
Anna (I feel strange calling myself `sweetmarie` - it`s the first time I have used an alternative to my real name. I got it from my favourite song - Absolutely Sweet Marie by Bob Dylan. This is of course irrelevant.
Posted by phillybob on March 10, 2001, at 16:19:40
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on March 10, 2001, at 13:13:55
< I was taking the 100 mg for a week and went up to 200 mg 2 days ago. I will then increase to 250 mg in another week. Having written it down, it seems like quite a `steep` increase.... Having said all of this, my psychiatrist had only put one other patient on Lamotragine (a woman who had `discovered` it on the Net). Prior to this, she hadn`t heard of the drug. >
Anna, I am not a doctor, but the risks of your dose increase are not worth it, right now. You must speak with a professional who has familiarity with lamotragine. That seems to be from what I've read to be a HUGE increase and that is not good even if you were taking NO valproate whatsoever.
I myself would speak with a professional. Perhaps, someone with familiarily of rashes and this drug might suggest dropping back to 100 mg and probably even lower until the rash goes away ... all the while monitoring it closely? Even then, increases, I don't think, are recommended at only up to 25 mg per two weeks (and maybe as little as one week).
I am taking 12.5mg/day to start and will then go by 12.5mg/day increases (Jah is doing the same).
[Bob Dylan rules]
Posted by sweetmarie on March 10, 2001, at 17:40:48
In reply to Re: treatment resistant depression » sweetmarie, posted by phillybob on March 10, 2001, at 16:19:40
> < I was taking the 100 mg for a week and went up to 200 mg 2 days ago. I will then increase to 250 mg in another week. Having written it down, it seems like quite a `steep` increase.... Having said all of this, my psychiatrist had only put one other patient on Lamotragine (a woman who had `discovered` it on the Net). Prior to this, she hadn`t heard of the drug. >
>
> Anna, I am not a doctor, but the risks of your dose increase are not worth it, right now. You must speak with a professional who has familiarity with lamotragine. That seems to be from what I've read to be a HUGE increase and that is not good even if you were taking NO valproate whatsoever.
>
> I myself would speak with a professional. Perhaps, someone with familiarily of rashes and this drug might suggest dropping back to 100 mg and probably even lower until the rash goes away ... all the while monitoring it closely? Even then, increases, I don't think, are recommended at only up to 25 mg per two weeks (and maybe as little as one week).
>
> I am taking 12.5mg/day to start and will then go by 12.5mg/day increases (Jah is doing the same).
>
> [Bob Dylan rules]It`s always good to find another Bob Dylan fan.
I guess that I assumd that my psychiatrist increased the dosage the way she did because that`s what what this specialist recommended. I don`t know how I could get a proffessional opinion without speaking to the bloke himself, which I would be reluctant to do. The rash has been around since I very first started on the Lamotragine at 25 mg. It hasn`t become any worse since the dosage was increased (a week and a half ago). I`m really not sure of what to do about the increase, i.e. who to ask - except, as I said this professor/specialist whose advice my own psychiatrist is taking (if you see what I mean). It`s a difficult one. I suppose I could try to get advice from another source, e.g. another psychiatrist, but I don`t think that Lamotragine is all that widely used. I might actually ask my sister (who is a trained psychiatric nurse, and see what she says. She may be able to make enquiries at her hospital.
Anna.
Posted by phillybob on March 10, 2001, at 19:33:04
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on March 10, 2001, at 17:40:48
Anna, sounds like a plan. Also, click on this link to another thread I posted in today for some good lamictal links in addition to the Dr. Ivan Goldberg one I posted earlier in this very thread (click on the one by the doctor as he has familiarity with lamictal):
http://www.dr-bob.org/babble/20010310/msgs/56133.html
Your sister should be able to find out what's up, though. The information is out there. It does sound better that the rash has not gotten worse since you started ... but, again, with the increase in dosage now, you should really have it monitored by someone (somehow!?) who knows what they are looking at it.
[I'm a big Wilco fan, particularly Jeff Tweedy, the lead singer, who's recently done some great solo shows ... I liken him to a future Bob Dylan ... he even sings a song about Bob Dylan's beard. :) ]
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