Psycho-Babble Medication Thread 101517

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Kramer: Help with atypical depression (resistant).

Posted by Sparkboy on April 2, 2002, at 16:09:22

I finally got a correct diagnosis in 1987. Tests showed (and continue to show) I am otherwise physically healthy. Parnate worked perfectly, but stopped working after 3 months. Retrials proved pointless. Re-uptake inhibitors are useless. Dexedrine augmenting Zoloft was counterproductive (no lift, irritability). Lithium, Tegretol no good. A trial of serotonin re-uptake enhancer tianeptine (Stablon) brought oversleeping in the summer and irritability.

What helps me now: moclobemide 75-150 mg/day, Neurontin 600 mg/day, Ambien 1-2 times a week. Have had oversleeping and leaden fatigue controlled for several years, but recently, intensified anxiety late in the year caused me to need Ativan 1.5-2 mg/day. I think the oversleeping of winter used to shut down some of the anxiety. Deliberate sleep deprivation one time (for a few days) brought on a severe anxiety attack, lasting 2 months (this was years ago).

What is disabling is the inability to be around people and form relationships for any length of time. Anxiety and sensitivity to criticism very problematic. Also flatness of warm feelings (restored when Parnate worked).

My questions:

Parnate was unique in being able to provide a true AD response, even among the MAOIs. Does the nature of Parnate suggest to you any improvements in my drug strategy?

Gepirone is scheduled for release in the second half of this year. Do you have any more precise info on a release date?

Would a trial of Lamictal be worth considering?


Thanks for any input.
--John

 

Re: Kramer: Help with atypical depression (resistant).

Posted by Dr. Kramer on April 2, 2002, at 21:27:09

In reply to Kramer: Help with atypical depression (resistant)., posted by Sparkboy on April 2, 2002, at 16:09:22

The fact that Parnate worked for 3 moths makes me wonder whether you are really bipolar, and cycling. As such, yes, Lamictal may be a good choice. Gepirone is very similar to BuSpar, and although I don't have very much knowledge about it, I doubt it's going to help much. I think mood stabilizers may work. The way you describe your depresive symptoms sounds like bipolar dx.

 

I Second That Emotion » Sparkboy

Posted by Zo on April 3, 2002, at 1:33:39

In reply to Kramer: Help with atypical depression (resistant)., posted by Sparkboy on April 2, 2002, at 16:09:22

For what it's worth, this bipolar person got a * strong* hit of bipolar off your post. .

Zo

 

Re: I Second That Emotion » Zo

Posted by Penny on April 3, 2002, at 8:45:45

In reply to I Second That Emotion » Sparkboy, posted by Zo on April 3, 2002, at 1:33:39

> For what it's worth, this bipolar person got a * strong* hit of bipolar off your post. .
>
> Zo

Zo,

Is it just me, or does it seem like there is a large number of possibly incorrect diagnoses regarding treatment-resistant depression (what I was too) vs. bipolar II? The *symptoms* of both seem quite similar...

Penny

 

Re: I Second That Emotion

Posted by Sparkboy on April 3, 2002, at 19:54:46

In reply to I Second That Emotion » Sparkboy, posted by Zo on April 3, 2002, at 1:33:39

> For what it's worth, this bipolar person got a * strong* hit of bipolar off your post. .
>
> Zo

That's interesting, but in the material I have (a book chapter on the topic), I do have the history and constellation of symptoms that define atypical depression, and it also stated a connection to seasonal affective disorder. Mine has always had a seasonal component, worse in winter with low sleep, high energy episodes in April and October. I hope I didn't mislead Dr. Kramer in suggesting Parnate only "seemed" to work once. I did 2 retrials of Parnate at later dates and each time it would kick in, giving me the mental clarity, remarkable calm and emotional warmth I'm sure most people take for granted. It just doesn't last. I'd crash off it sooner each time. One time I was on Klonopin for severe anxiety and did a retrial of Parnate. When the Parnate kicked in after a week, I took the next dose of Klonopin and it about knocked me over (went off it cold-turkey). Parnate seemed to provide an actual correction, whereas my other meds have all been band-aid stuff in comparison. I went on Neurontin because of it's off-label rep for helping anxiety and it does help modestly for that. I realize Klonopin is a stabilizer also, but neither stopped the cycling or helped depression.

I suppose debating over a dx is academic as long we find the med that helps, but I would like to hear more about the bipolar "hit" you guys seem to be getting. My shifts have always been seasonal and fairly predictable and the standard bipolar meds were like water.

Thanks.
--John

 

Re: I Second That Emotion

Posted by crepuscular on April 4, 2002, at 0:53:12

In reply to Re: I Second That Emotion, posted by Sparkboy on April 3, 2002, at 19:54:46

despite the scary risks of atypicals, i have found seroquel to work much better than anticonvulsants. i'm still concerned about the danger of TD/NMS, but i do think a sizable body of evidence regarding their efficacy in certain types of depression is well on the way to being established. of course OldSchool is right to mention the risks and they certainly do not work for everybody. my 2c...

 

Benefit of Seroquel? » crepuscular

Posted by Sparkboy on April 4, 2002, at 13:52:19

In reply to Re: I Second That Emotion, posted by crepuscular on April 4, 2002, at 0:53:12

Does it give you an AD response or anxiety relief? Are you on a low dose? My primary thing now is crippling anxiety, fear of social interaction, lack of warmth, and indecision (fear related). Wake up with a mild anxiety attack each morning (have to face another day). It feels like standing in the center of a mine field.

I get along well with most people but live in mortal dread of those few fringe people in any setting (like a job) who like to undermine wherever they sense vulnerability. That's human nature, of course, but it drives me to distraction when it occurs. Social life will become possible when I feel good enough to stop sending off those victim signals. Sorry for rambling, but this is one of the few places I think people can relate.

--John

 

Re: Benefit of Seroquel?

Posted by crepuscular on April 4, 2002, at 14:18:11

In reply to Benefit of Seroquel? » crepuscular, posted by Sparkboy on April 4, 2002, at 13:52:19

well, i wasn't having any anxiety when i started it, i was manic and not sleeping. nice at first, but then paranoid and angry. very much the opposite of social phobia i guess - i was in peoples faces constantly!

seroquel restored my sleep pattern, but it also slowed my mood cycling down to the point where i don't really know "where" it is. i am also now able to take zoloft (low dose) which i could only do for a few weeks before it made me deliciously hypomanic. i'm at 100mg seroquel, which is a low dose. but peoples response to this med is all over the place.

have you tried SSRI's (sure ya have)? they always made me fearless of people and situations. of course this probably was also some hypomania which makes one socially outgoing.

in terms of an antidepressant response, my answer is *yes*, but more in an amplitude damping sense. not in the usual way that i response to an antidepressant - which is good.

it does chill one out, so it could work for anxiety i suppose. but how about klonopin? nothing beats a benzo for anxiety imho.

> Does it give you an AD response or anxiety relief? Are you on a low dose? My primary thing now is crippling anxiety, fear of social interaction, lack of warmth, and indecision (fear related). Wake up with a mild anxiety attack each morning (have to face another day). It feels like standing in the center of a mine field.
>
> I get along well with most people but live in mortal dread of those few fringe people in any setting (like a job) who like to undermine wherever they sense vulnerability. That's human nature, of course, but it drives me to distraction when it occurs. Social life will become possible when I feel good enough to stop sending off those victim signals. Sorry for rambling, but this is one of the few places I think people can relate.
>
> --John

 

Re: Benefit of Seroquel? » crepuscular

Posted by Sparkboy on April 4, 2002, at 21:05:24

In reply to Re: Benefit of Seroquel?, posted by crepuscular on April 4, 2002, at 14:18:11

> have you tried SSRI's (sure ya have)? they always made me fearless of people and situations. of course this probably was also some hypomania which makes one socially outgoing.

Yeah, but no mood benefits I'm aware of. Zoloft stopped a little OCD I had at one point (fingering my hair). There does seem to be something serotonergic about my problem though; when I tried tianeptine (serotonin re-uptake enhancer), it brought on oversleeping in the summer, something I never had before. That suggests a serotonin relationship to the seasonal part.

> it does chill one out, so it could work for anxiety i suppose. but how about klonopin? nothing beats a benzo for anxiety imho.

I could've had Klonopin again if I'd wanted it, but asked for Ativan. I wanted something with a little shorter half-life so I can regulate according to my need rather than just being ON something 24 hours a day. It's a band-aid that doesn't deal with the underlying fear and depression.

Oddly, my winter episodes used to be just oversleeping, depression, and leaden fatigue, but in the last couple of years, early Nov. means the onset of anxiety attacks. The benzo controls it enough so I can sleep. If I stop sleeping, it's like a complete short-circuit feedback loop. Like having my finger stuck in a light socket. I wised up last fall and added a benzo to my regimen before things got out of hand. I think my med regimen before eliminated oversleeping and leaden fatigue, but cut off the escape route from anxiety.

Glad you found something that works.
--John


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