![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 30. Go back in thread:
Posted by Penny on March 6, 2002, at 8:49:41
In reply to What's the point of drugs that make yr life worse?, posted by Automated Lady on March 6, 2002, at 7:18:44
Your description of your depression sounds much like mine.
I sooooo agree with Alan. I, too, have been through three pdocs in order to find one who knows what he's doing. My first would write me a script and send me out the door for another three months to self-medicate (if you don't feel better in a week, up the dose...). My second did try some polypharmacy, but his theory was simply "More is better," regardless of the side effects I was having from being on too high a dose of Paxil.
My current pdoc is fabulous, really listens, and told me there are MANY roads we haven't tried yet medication wise (I've been on Effexor, Celexa, Paxil & Wellbutrin, plus Seroquel & Trazodone for sleep) and that he is very optimistic about my treatment. Thank goodness, b/c I have a hard time being optimistic about anything! But, I trust him.
I found him by looking for a pdoc who was somewhat involved in clinical research. I think that those who are might have more insight into possible "treatment resistent" or severe chronic depression. So, you may need to find a new pdoc who is willing to work with you on this.
And another option to consider (and it's certainly not for everyone) is ECT. I can't speak from personal experience, but I believe the board here has a good amount of information from folks who can.
Good luck.
Penny> I have to put this in, because I am getting to a point of despair about ever recovering from my depression.
>
> I have been seriously depressed since I was 18 (although I have had symptoms of depression from a very young age) and have tried Prozac, Efexor and Celexa. Each one of these has affected my life in such a way as to make it worse rather than better. Although ADs have lifted me out of the darkest moods, they have also made me so tired I have had to sleep 15 hours a day, changed my appetite so that I have been scared and incapacitated by my compulsive eating, made me lethargic and numb, made me not care about my life enough to try and change it.
>
> I am sick of being in this mess, which is that I can't cope without ADs and can't cope with them. I am trying to do a university course and am failing miserably because I can't get myself together enough to do any work, talk to anyone or go to any classes.
>
> I have an NHS doctor who is not interested in combining drugs or trying anything unusual (eg. MAOIs) - he isn't even interested in the fact that my depression is different from the "classic" type (it's atypical). I feel like in order to get any real help I will have to do something desperate, and I have no wish to do that. I just want my life back.
>
> I apologise for being very negative, but I would really appreciate some advice.
>
> AL
Posted by colin wallace on March 6, 2002, at 11:41:04
In reply to Re: What's the point of drugs that make yr life worse? » Automated Lady, posted by Penny on March 6, 2002, at 8:49:41
Really must underscore what's been said here- I 've had a GP who had stubborn and unyielding opinions which directly contrasted with my own good reason, instinct and common sense.Eventually, I applied the same logic as is recommended for antidepressant trials: if, after an adequate length of time and at an adequate dose, no improvement (or worsening)occurs, a switch is appropriate.
Seems you've had more than an adequate dose of this GP, and for long enough.
You really need to feel some kind of rapport, and that he/she is willing to consider your opinions and feedback.This is obviously lacking here.
Also, insist on getting a psychiatric referral, if you aren't already seeing one.You'll feel so much better speaking to somebody who is both knowledgeable and sympathetic.Wishing you well.
Posted by Hawkeye on March 6, 2002, at 12:08:15
In reply to What's the point of drugs that make yr life worse?, posted by Automated Lady on March 6, 2002, at 7:18:44
Try SAMe. It works for many and is without side effects. The cost has gone down considerably. If there is a COSTCO near you - buy it there ($45 for 80 tabs of Nature Made Brand -the best). Use the full therapeutic dose of 800-1600mgs per day. CVS now has its own brand that is reasonably priced also.
Posted by JohnX2 on March 6, 2002, at 12:46:21
In reply to What's the point of drugs that make yr life worse?, posted by Automated Lady on March 6, 2002, at 7:18:44
Hi,I don't know what happened with your good
medicines. I think this is a common problem
though that I ran into: find a few good meds
that have one or 2 snags.I believe it may be possible to find happiness on
those medicines if you have a good pdoc/better
information. Too many people blame the problem
(not you necessarily) on the medicine instead
of the process of getting to the medicine and
the follow ups.I'll throw out examples, maybe a lot of
people do well on certain SSRIs but have unbearable
bruxism (teeth grinding). What to do?Crummy doctors find it easiest to use the most
simple scientific trial and error method on
planet earth which is process of elimination.Therefore, if you don't like a medicine, let's
just swizzle the patient to another one. Never
mind doing a little investigation to see if I
(doctor) can treat the little nuiance to make
the medication that is mostly working solvable.Ok, now onto the good doctors. Maybe there are
some with some good DEDUCTIVE thinking skills that
can identify trends in your good and bad responses
and focus on addressing those trends instead of
putting you through the swizzle game. Back to
bruxism, a lot of people complain about this problem
but how many pdocs know how to fix it (god knows
there are so many little anti-dotes to try) and
how many would just find it easier to swizzle the
patient onto another medicine where enevitably
the patient will encounter some OTHER problem
that makes medication unbearable.I'm sorry but my take is that good physicians
should have some sort of training in the past
that required them to solve really tough scientific
problems using analytical deduction. A lot of
doctors don't have scientific backgrounds, go
to medical school , learn what they do via
memorization , solve problems with simple
process of elimination, and turn into what I call
"walking flowcharts". If the flowcharts on
giving medicines don't give out all these little
"secrets" on how to make medicines valuable,bearable
or how to put 2 and 2 together from YOUR
history to maybe get a better dx on you,etc , then
the doctor may never find a good treatment for you.Another good example is the starting dx. This
is more important than the medicine. How many
people do I know that don't get the right dx and
then take the wrong meds? Bipolars treated with
unipolar meds, etc. Again, its not always obvious
from an initial exam if you are sly bipolar II.
But maybe after taking 5 anti-depressants, getting
2 hypomanic responses that petered out, instead
of continuing to use process of elimination along
the major depression medicine path the good doc
should look at the trend, use some deduction, and
say, hey maybe this patient is bipolar.Unfortunately I think I am being too idealistic
about finding these docs. They are overbooked.So sometimes people come here, and I give suggestions
as well as others on how to make a medicine more
bearable to improve the odds of making through
the trial to get a response or stay on a medicine
with 1 or 2 snags, or get a better dx. My suggestions
or "secrets" maybe they are, are usually known by at least
a few other people here, (a lot of time we learned
these by BEING BURNT), but the person posting
came here with the question leading me to believe
that his attending physician isn't up on the
"secrets" and using a little deductive thinking.-John
> I have to put this in, because I am getting to a point of despair about ever recovering from my depression.
>
> I have been seriously depressed since I was 18 (although I have had symptoms of depression from a very young age) and have tried Prozac, Efexor and Celexa. Each one of these has affected my life in such a way as to make it worse rather than better. Although ADs have lifted me out of the darkest moods, they have also made me so tired I have had to sleep 15 hours a day, changed my appetite so that I have been scared and incapacitated by my compulsive eating, made me lethargic and numb, made me not care about my life enough to try and change it.
>
> I am sick of being in this mess, which is that I can't cope without ADs and can't cope with them. I am trying to do a university course and am failing miserably because I can't get myself together enough to do any work, talk to anyone or go to any classes.
>
> I have an NHS doctor who is not interested in combining drugs or trying anything unusual (eg. MAOIs) - he isn't even interested in the fact that my depression is different from the "classic" type (it's atypical). I feel like in order to get any real help I will have to do something desperate, and I have no wish to do that. I just want my life back.
>
> I apologise for being very negative, but I would really appreciate some advice.
>
> AL
Posted by JohnX2 on March 6, 2002, at 12:58:03
In reply to Re: Medication Swizzle game vs. good docs, posted by JohnX2 on March 6, 2002, at 12:46:21
PS irony: the swizzle game makes some pdocs more
money.-John
>
> Hi,
>
> I don't know what happened with your good
> medicines. I think this is a common problem
> though that I ran into: find a few good meds
> that have one or 2 snags.
>
> I believe it may be possible to find happiness on
> those medicines if you have a good pdoc/better
> information. Too many people blame the problem
> (not you necessarily) on the medicine instead
> of the process of getting to the medicine and
> the follow ups.
>
> I'll throw out examples, maybe a lot of
> people do well on certain SSRIs but have unbearable
> bruxism (teeth grinding). What to do?
>
> Crummy doctors find it easiest to use the most
> simple scientific trial and error method on
> planet earth which is process of elimination.
>
> Therefore, if you don't like a medicine, let's
> just swizzle the patient to another one. Never
> mind doing a little investigation to see if I
> (doctor) can treat the little nuiance to make
> the medication that is mostly working solvable.
>
> Ok, now onto the good doctors. Maybe there are
> some with some good DEDUCTIVE thinking skills that
> can identify trends in your good and bad responses
> and focus on addressing those trends instead of
> putting you through the swizzle game. Back to
> bruxism, a lot of people complain about this problem
> but how many pdocs know how to fix it (god knows
> there are so many little anti-dotes to try) and
> how many would just find it easier to swizzle the
> patient onto another medicine where enevitably
> the patient will encounter some OTHER problem
> that makes medication unbearable.
>
> I'm sorry but my take is that good physicians
> should have some sort of training in the past
> that required them to solve really tough scientific
> problems using analytical deduction. A lot of
> doctors don't have scientific backgrounds, go
> to medical school , learn what they do via
> memorization , solve problems with simple
> process of elimination, and turn into what I call
> "walking flowcharts". If the flowcharts on
> giving medicines don't give out all these little
> "secrets" on how to make medicines valuable,bearable
> or how to put 2 and 2 together from YOUR
> history to maybe get a better dx on you,etc , then
> the doctor may never find a good treatment for you.
>
> Another good example is the starting dx. This
> is more important than the medicine. How many
> people do I know that don't get the right dx and
> then take the wrong meds? Bipolars treated with
> unipolar meds, etc. Again, its not always obvious
> from an initial exam if you are sly bipolar II.
> But maybe after taking 5 anti-depressants, getting
> 2 hypomanic responses that petered out, instead
> of continuing to use process of elimination along
> the major depression medicine path the good doc
> should look at the trend, use some deduction, and
> say, hey maybe this patient is bipolar.
>
> Unfortunately I think I am being too idealistic
> about finding these docs. They are overbooked.
>
> So sometimes people come here, and I give suggestions
> as well as others on how to make a medicine more
> bearable to improve the odds of making through
> the trial to get a response or stay on a medicine
> with 1 or 2 snags, or get a better dx. My suggestions
> or "secrets" maybe they are, are usually known by at least
> a few other people here, (a lot of time we learned
> these by BEING BURNT), but the person posting
> came here with the question leading me to believe
> that his attending physician isn't up on the
> "secrets" and using a little deductive thinking.
>
> -John
>
>
> > I have to put this in, because I am getting to a point of despair about ever recovering from my depression.
> >
> > I have been seriously depressed since I was 18 (although I have had symptoms of depression from a very young age) and have tried Prozac, Efexor and Celexa. Each one of these has affected my life in such a way as to make it worse rather than better. Although ADs have lifted me out of the darkest moods, they have also made me so tired I have had to sleep 15 hours a day, changed my appetite so that I have been scared and incapacitated by my compulsive eating, made me lethargic and numb, made me not care about my life enough to try and change it.
> >
> > I am sick of being in this mess, which is that I can't cope without ADs and can't cope with them. I am trying to do a university course and am failing miserably because I can't get myself together enough to do any work, talk to anyone or go to any classes.
> >
> > I have an NHS doctor who is not interested in combining drugs or trying anything unusual (eg. MAOIs) - he isn't even interested in the fact that my depression is different from the "classic" type (it's atypical). I feel like in order to get any real help I will have to do something desperate, and I have no wish to do that. I just want my life back.
> >
> > I apologise for being very negative, but I would really appreciate some advice.
> >
> > AL
Posted by JohnX2 on March 6, 2002, at 13:19:52
In reply to What's the point of drugs that make yr life worse?, posted by Automated Lady on March 6, 2002, at 7:18:44
most doctors are paid (is an NHS doc paid somehow even if not by
you directly?).
You are a consumer.
If you brought your car to a crummy mechanic
you wouldn't think twice about getting a 2nd
opinion. No guilty feelings questioning the mechanic.
YOU'RE the consumer.You obviously need a new pdoc,
what part makes you feel desperate?
Is it questioning the authority of someone like
a doctor? This can be difficult, especially when
depressed. But you are still miserable, so no
prob questioning this yahoo and moving onto someone
else. I hope you can establish good contacts/resources.Best wishes,
John
> I have an NHS doctor who is not interested in combining drugs or trying anything unusual (eg. MAOIs) - he isn't even interested in the fact that my depression is different from the "classic" type (it's atypical). I feel like in order to get any real help I will have to do something desperate, and I have no wish to do that. I just want my life back.
Posted by trouble on March 6, 2002, at 23:20:59
In reply to Re: What's the point of drugs that make yr life worse?, posted by colin wallace on March 6, 2002, at 11:41:04
Sorry to be so redundant, but I'm in the same boat as you in many respects, I'm not sure if my problems are side effects or psychological and that's paralyzing. But I've had the same pdoc for 3 years and he is an out-of-the-box thinker, totally unfazed by what I'm gooing through and patient about my efforts to articulate what's gooing on. I am real intune w/the workings of my mind, but abysmally out of touch w/my body, and just can't put physical problems into words.
Anyway, I once told my pdoc that I try to be in a cheerful mood when I go see him and he told me not to do that, please don't try to take care of him, it would only complicate things more than they are.
He also once said something that impressed me about the complexities of the brain, how if he were a mechanic some clients would be an Oldsmobile and others would be a Jagguer, and it's his job to know which is which.
All his predecessors were just as expensive as him, but most of them wouldn't even make eyecontact w/me during our 15 minute sessions. Just in and out, and that can be appropriate for the more savvy clients, but I needed dozens of trials just to beat the major depression. Would I still be depressed if I hadn't finally found my mechanic? Possibly! Or dead. I'm afraid I've gone off topic here, but just wanted to offer encouragement in your search for a good one, it's worth the effort.
trouble
Posted by trouble on March 6, 2002, at 23:26:04
In reply to Re: Medication Swizzle game vs. good docs, posted by JohnX2 on March 6, 2002, at 12:46:21
Posted by trouble on March 6, 2002, at 23:28:23
In reply to Re: Medication Swizzle game vs. good docs, posted by JohnX2 on March 6, 2002, at 12:58:03
Posted by JohnX2 on March 6, 2002, at 23:32:22
In reply to sorry again but what is bruxism? thanks! (nm), posted by trouble on March 6, 2002, at 23:28:23
BRUXISM = jaw/teeth grinding/clenching. ARGGGHHH!!!
Posted by JohnX2 on March 6, 2002, at 23:36:51
In reply to is dx diagnosis, what about a NHS dr? thanks (nm), posted by trouble on March 6, 2002, at 23:26:04
Posted by lizzyg on March 7, 2002, at 7:19:21
In reply to Re: dx = diagnosis, yes (nm) » trouble, posted by JohnX2 on March 6, 2002, at 23:36:51
Dear John - I wonder if I, too, could ask for the benefit of your wisdom, please? Here in the UK, because our medical treatment is 'free', it's difficult to have consumer choice in doctors and psychiatrists. All the GPs (family doctors) I've had have been uninformed on the subject of depression, and it's quite difficult to get referred to a psychiatrist. I only have once - he was good, but the setting was distressing.
I had my first attack of depression and anxiety 19 years ago at the age of 20. Experiences with doctors were bad, but I was eventually treated with amitriptyline and a benzo which worked fine. Next two times - three and five years later - I was loath to get medical help and just waited for the episodes to resolve, which they did over a period of months. Ten years ago I had a bad attack and saw a psychiatrist. Tried a couple of SSRIs which drove me up the wall, but had success with Lofepramine (third generation tricyclic not available in US) and a short course of Diazepem. This treatment also worked well in my last spate of depression six years ago.
I have been symptom free since, until a couple of months ago. All previous attacks have been totally endogenous in nature, but this depression/anxiety was triggered by bereavement. I tried the Lofepramine again, but found I couldn't tolerate it. Could it be that my metabolism has changed in the intervening years (I've had two more babies in the meantime)? I gave Citalopram a go for two weeks, but couldn't cope with the increased anxiety, agitation, insomnia, and weight loss (7 pounds). So I tried Mirtazapine, but found the sedation a real problem and didn't stick with it. This depressive episode also doesn't seem as severe as previously, so maybe that's why the side effects are proving such a barrier: I guess when you're more desperate you can put up with more. I'm cutting my unhelpful GP out of the loop and trying SAM-e, but if that doesn't work I think I'll have to push to see a psychiatrist. Maybe I should have another go with the tricyclic with something to counteract side effects, or give Nefadazone a try...
I'd be very grateful for any insights you may have, John.
With thanks
Lizzy
Posted by Daky on March 7, 2002, at 17:00:43
In reply to Doctors and medications » JohnX2, posted by lizzyg on March 7, 2002, at 7:19:21
Lizzy,
Since you are in the UK perhaps you can shed some light on how one does go about finding a psychiatrist there. My daughter is studying in London this year and is currently on medication for depression (Wellbutrin) and also takes a small dose of Lorazepam. She went to the doctor today (a family doctor recommended by her school)because she is more depressed and he wants her off all psych meds. He said he doesn't agree with the American system and thinks all psych drugs are bad and mask the real problems. He wants her in group therapy for an eating disorder, which he diagnosed by asking her a bunch of questions. She is overeating because she is depressed (she doesn't binge, purge or starve.) I want another opinion but how do you go directly to a pdoc in the UK? I am so frustrated I could scream!
Posted by lizzyg on March 8, 2002, at 4:22:20
In reply to Re: Doctors and medications, posted by Daky on March 7, 2002, at 17:00:43
> Lizzy,
> Since you are in the UK perhaps you can shed some light on how one does go about finding a psychiatrist there. My daughter is studying in London this year and is currently on medication for depression (Wellbutrin) and also takes a small dose of Lorazepam. She went to the doctor today (a family doctor recommended by her school)because she is more depressed and he wants her off all psych meds. He said he doesn't agree with the American system and thinks all psych drugs are bad and mask the real problems. He wants her in group therapy for an eating disorder, which he diagnosed by asking her a bunch of questions. She is overeating because she is depressed (she doesn't binge, purge or starve.) I want another opinion but how do you go directly to a pdoc in the UK? I am so frustrated I could scream!Daky - the situation over here is that you have to be referred to a psychiatrist by your GP (family doctor). I've lived in London for 16 years, and have been with four different GP practices in different areas, and haven't found one where there is a doctor with a decent knowledge of depression/anxiety. A couple have grudgingly prescribed medication but insisted I also see a psychotherapist, who has promptly confirmed what I already knew - that my problem is biochemical. There seems to be some sort of puritanical attitude amongst the generalist doctors that medications are 'bad' and talking therapies are 'good'.
You can either see a psychiatrist free of charge on the National Health System, but they have a limited amount of time to spend with you, or you can pay to see a private practitioner. In both cases, however, you have to have a referral note from your GP. Your daughter can either try to find a different and more sympathetic GP, or go directly to a private doctor who might be more willing to refer. Two sources to look at are e-med.co.uk and doctorcall.co.uk. The Priory Clinic is the best-known private psychiatric facility in London; I've just looked at their website and you can actually contact them directly, so she might want to try that. It's prioryhealthcare.co.uk.
Good luck.
Lizzy
Posted by Automated Lady on March 8, 2002, at 5:13:06
In reply to Re: What's the point of drugs that make yr life worse? » Automated Lady, posted by Alan on March 6, 2002, at 8:25:21
I think you're right, Alan, that is basically the problem. I'm in the UK and am going through the NHS, and I think they just don't have the resources to automatically refer to a psychiatrist (is that what you mean by pdoc?) for depression. Usually an ordinary GP prescribes off a list of meds that is tried in the same order for every patient. I'll just have to really push for more specialised help.. (maybe move to a richer part of the country!) AL
Posted by Automated Lady on March 8, 2002, at 5:29:46
In reply to Re: What's the point of drugs that make yr life worse? » Automated Lady, posted by JohnX2 on March 6, 2002, at 13:19:52
I suppose it's just that every doctor I've had has made me feel guilty for asking for more than the "5 mins in the room, quick prescription and away" formula. I think there is still a culture of not taking depression really seriously (I once saw a doc while I was at uni and cried in her office because I couldn't make myself get out of bed or do any work, and she told me "There are two trains... the emotional and the logical... you have to get off the first and on to the second..." and sent me away without medication. I am only just starting to demand a bit more and I find it very hard. Anyway, thanks to everyone for the advice. AL
Posted by Automated Lady on March 8, 2002, at 5:44:36
In reply to Doctors and medications » JohnX2, posted by lizzyg on March 7, 2002, at 7:19:21
Never heard of it!
Posted by JohnX2 on March 8, 2002, at 6:15:35
In reply to Doctors and medications » JohnX2, posted by lizzyg on March 7, 2002, at 7:19:21
Hi there,Rats about the health care in your country.
I've been saddened to hear all the stories coming
out of Europe.I read your note carefully. I have a quick idea (Sorry I'm
about to go to bed, but i'll send a quick reply).
Mind you, I'm not a doctor.It sounds like if you have some good leftovers the
Celexa and Mirtazepine (Remeron, US) may work well *together*.
The Celexa is causing insomnia, agitation, weight loss.
And the Remeron is causing sedation. I don't know what dose
you took Remeron at, but at 15 mg it is sedating, as you
bump it to 30+ mg, it is less sedating and more of an anti-depressant.
Now, I've seen a lot of people *combine* an SSRI like Celexa with Remeron and get
a nice effect where Remeron wipes out the agitation/insomnia caused
by the SSRI. Also the Remeron increases appetite. Sounds like
a good balancing act. Also the 2 medicines would work well
synergistically at the serotonin system to get a very good anti-depressant
effect, fewer side effects, less anxiety, quicker response. If you feel drowsy,
you can raise the Remeron dose to get more anti-depressant response as
this boosts a 2nd stimulant chemical (norepinephrine).Believe me taking the Remeron with the SSRI will substantially
change the feeling the SSRI gives you.You can do this and also augment it with SAM-E
Your other ideas sounded reasonable too, but all the medicines
have their quirks to deal with. It just looked like the
Remeron + Celexa combo could balance out nicely.What doses did you take of those meds?
Please hang in there. You'll feel better soon.
-John
> Dear John - I wonder if I, too, could ask for the benefit of your wisdom, please? Here in the UK, because our medical treatment is 'free', it's difficult to have consumer choice in doctors and psychiatrists. All the GPs (family doctors) I've had have been uninformed on the subject of depression, and it's quite difficult to get referred to a psychiatrist. I only have once - he was good, but the setting was distressing.
>
> I had my first attack of depression and anxiety 19 years ago at the age of 20. Experiences with doctors were bad, but I was eventually treated with amitriptyline and a benzo which worked fine. Next two times - three and five years later - I was loath to get medical help and just waited for the episodes to resolve, which they did over a period of months. Ten years ago I had a bad attack and saw a psychiatrist. Tried a couple of SSRIs which drove me up the wall, but had success with Lofepramine (third generation tricyclic not available in US) and a short course of Diazepem. This treatment also worked well in my last spate of depression six years ago.
>
> I have been symptom free since, until a couple of months ago. All previous attacks have been totally endogenous in nature, but this depression/anxiety was triggered by bereavement. I tried the Lofepramine again, but found I couldn't tolerate it. Could it be that my metabolism has changed in the intervening years (I've had two more babies in the meantime)? I gave Citalopram a go for two weeks, but couldn't cope with the increased anxiety, agitation, insomnia, and weight loss (7 pounds). So I tried Mirtazapine, but found the sedation a real problem and didn't stick with it. This depressive episode also doesn't seem as severe as previously, so maybe that's why the side effects are proving such a barrier: I guess when you're more desperate you can put up with more. I'm cutting my unhelpful GP out of the loop and trying SAM-e, but if that doesn't work I think I'll have to push to see a psychiatrist. Maybe I should have another go with the tricyclic with something to counteract side effects, or give Nefadazone a try...
>
> I'd be very grateful for any insights you may have, John.
>
> With thanks
>
> Lizzy
Posted by lizzyg on March 8, 2002, at 6:45:56
In reply to What is SAME-e? » lizzyg, posted by Automated Lady on March 8, 2002, at 5:44:36
Dear AL - SAM-e is a compound which has apparently been used to successfully treat depression (and a number of other complaints) in Italy for 20 years. It took off in the US a couple of years ago, but seems virtually unknown over here in the UK. I've just started using the product recently and am no expert, but others on this board such as Ron Hill are very knowledgeable. A couple of overview articles can be found at depressionremedy.com and smartbodyz.com. It's quite difficult to get hold of SAM-e in this country, but you can order online from the States.
I think it's worth a try because - like you - I have been suffering with side effects from the ADs I've tried this time round. My experiences with GPs have also been unremittingly dire, and I live in an affluent area of London. Most of the people posting here know 10 times as much about depression and anxiety as the average GP!
Best wishes
Lizzy
Posted by lizzyg on March 8, 2002, at 7:23:33
In reply to Re: Doctors and medications » lizzyg, posted by JohnX2 on March 8, 2002, at 6:15:35
John - thanks a lot for your input. That sounds like a good strategy: the Citalopram and Mirtazapine could complement each other well and 'cancel' the negative side effects of each.
My doctor would have a fit if I suggested combining meds; when I started on the Mirtazapine I had to give back the left-over Citalopram! So I think I'll give the SAM-e a decent trial and, if that doesn't work, push hard to see a psychiatrist, who might be more amenable to trying new things.
Best wishes
Lizzy
Posted by Daky on March 8, 2002, at 12:37:40
In reply to Re: Doctors and medications » Daky, posted by lizzyg on March 8, 2002, at 4:22:20
Hi Lizzy,
Thanks for your help. I will check out the websites your suggested. My daughter just got the names of 4 pdocs from her school advisor so she may take a shot at one of them. The situation you described is exactly what she is experiencing. The doctor she saw bashed the American psyciatric system and all psych meds. Thanks again. Sorry for juming in on your thread!
Daky
Posted by Ron Hill on March 8, 2002, at 15:13:04
In reply to What is SAME-e? » lizzyg, posted by Automated Lady on March 8, 2002, at 5:44:36
> Never heard of it!
AL,You asked about SAM-e and because it has absolutely given me back my life, I am eager to tell other of my good fortune in hopes that it may help many more people. Here is a description of what it did for me and what it is:
I'm Bipolar II. Lithobid adequately controls my hypomania but does nothing for my depression. Any of the SSRI's will take away my "I want to die" mood but leave me with side effects (loss of ambition, loss of energy, lack of motivation, blunted emotions, etc). I have tried a ton of other ADs over the years, but I will not bore you with the details.
Four months ago I went to my regularly scheduled visit with my pdoc. At the time, I was only taking Li because of the AD side effects and, therefore, depression was a problem. My pdoc had recently reviewed several studies showing success in treating depression using SAM-e in conjunction with an AD and success using SAM-e alone. He suggested that I take two 200 mg SAM-e tablets daily in conjunction with 25 mg of Zoloft. (I am hypersensitive to most medication so I take small doses). Initially, I was skeptical because over the years I have taken a lot of over-the-counter supplements, most of which did very little to ease my depression. But I told my pdoc that I would give it a try.
Initially I could only take one 200 mg tablet of SAM-e every other day. If I took more, I would experience side effects (flush, nausea, confused thinking, general ill feeling, "skin crawling"). However,within about five days, my depression began to lift and I now have my life back. Yeah!!! Currently, I take one 200 mg tablet daily without any adverse side effects. In total I daily take 600 mg Lithobid, 12.5 mg Zoloft, and 200 mg SAM-e. Eventually, I plan to discontinue the small amount of Zoloft.
Bottom line: 200 mg SAM-e daily has helped me more than any of the many ADs I've tried over the years.
It is very important to take plenty of B-6, B-12 (use sublingual form) and folate with the SAM-e to prevent the build up of homocystiene. Also, SAM-e is absorbed more efficiently by the small intestines when it is taken on an empty stomach. However, I usually eat a small bite ot food to reduce nausea. SAM-e, like many perscription ADs, can induce mania in bipolar patients if the patient is not taking an adequate amount of a mood stablizer.
SAM-e is a naturally occurring compound and is manufactured by the human body. However, some people do not produce enough of it and supplementation may be beneficial.
SAM-e is involved in a plethora of various biochemical reactions in the human body. It functions as a very important methyl group donor. With regard to mood and related brain chemistry, SAM-e serves as the methylating agent in the biochemical reaction mechanism whereby various neurotransmitters (serotonin and dopamine in particular) are synthesized from the amino acids in dietary protein.
For me personally, SAM-e has turned out to be a lifesaver! I have waited to post on this topic until I gave it some time to make sure it did not poop out right away. So far I have four months of excellent results and absolutely no hint of poop out.
Here are some links to articles on the topic. Do some research (use "SAM-e" in search engine). Buy a good name brand to ensure product quality.
http://www.biopsychiatry.com/sameart.html
http://more.abcnews.go.com/sections/living/inyourhead/allinyourhead_36.html
http://www.psycom.net/depression.central.same.html
http://www.mhsource.com/expert/exp1041299b.html
http://www.arthritissupport.com/track/goto/rtgoto30l.cfm
-- Ron
--------------------------------------------------
Posted by New one on March 9, 2002, at 2:09:24
In reply to Re: What is SAME-e?, posted by Ron Hill on March 8, 2002, at 15:13:04
Hi. Thanks, Ron, for all your good info about sam-e. I am glad it has helped you so much.
I take Wellbutrin now, which seems to do OK supplying me with the extra dopamine and norephedrine I seem to need. I have been told (and feel this myself) that I also need more serotonin in the system.Would sam-e be more helpful along the norephedrine/dopamine line rather than the serotonin? Should I try St. John's wort rather than Sam-e as long as I am taking Wellbutrin?
Thanks for any feedback you can give.
New One
Posted by beardedlady on March 9, 2002, at 6:19:31
In reply to Re: What is SAME-e?, posted by New one on March 9, 2002, at 2:09:24
My two cents, sorry:
Your body makes Sam-e natually; it doesn't make St. John's Wart. The latter has a lot of drug interaction problems.
beardy : )>
Posted by Ron Hill on March 9, 2002, at 13:22:36
In reply to Re: What is SAME-e?, posted by New one on March 9, 2002, at 2:09:24
> Would sam-e be more helpful along the norephedrine/dopamine line rather than the serotonin?
In most of the articles I've read it is stated that SAM-e enhances the production of serotonin and dopamine. However, in at least one article, serotonin and norepinephrine were identified. Personally, from the way it makes me feel, I think it is primarily a serotonin/dopamine thing. But that is just my layman's opinion. SAM-e allows me to be happy and in an "up mood" (serotonin) and energetic, optimistic, enthusiastic, goal oriented, emotional, etc (dopamine) without causing me to become overly irritable (too much norepinephrine). As an aside, Wellbutrin makes me very irritable (GRRRR!).
As you know, I currently use SAM-e as an add-on to a small amount of an SSRI (12.5 mg/day Zoloft). Without the SAM-e the Zoloft allows me to feel generally content (serotonin) but totally unmotivated with blunted emotions (low dopamine). There are some data that support the idea that SSRI's inadvertently lower dopamine levels. I believe that this is what happens to me when taking an SSRI and that the SAM-e helps to restore balance to the serotonin/dopamine equation. Beware, however, everything I've just said may, in reality, be merely "layman pdoc mumbo jumbo".
>Should I try St. John's wort rather than Sam-e as long as I am taking Wellbutrin?
There are good clinical data showing the effectiveness of SAM-e. To my knowledge, the same cannot be said for St. John's Wort. Having said that, I have never tried St. John's and, therefore, I can not report first hand regarding its effectiveness.
I suggest that you read all of the articles linked in my previous post, search for "SAM-e" with your search engine and read those articles, then decide if it is worth a try. In my opinion, it almost certainly will not hurt you and may, in fact, turn out to be a good add-on to your current AD (Wellbutrin) therapy. {Keep in mind that SAM-e is counter indicated for bipolar patients if they are not on an adequate mood stabilizer}.
Best Wishes New One!
-- Ron
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.