Psycho-Babble Medication Thread 101656

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Kramer: does depression ever stay in remission?

Posted by allisonm on April 3, 2002, at 7:41:57

Dear Dr. Kramer,

A little over four years ago, I was diagnosed with major depression, single episode, moderate. I have tried Effexor, Zoloft, Remeron, lithium, Wellbutrin, Neurontin, Celexa, and Serzone for at least a couple of months (except for Zoloft, Celexa, and Effexor). I have taken Remeron, Wellbutrin for several years; Serzone for slightly more than a year. Currently taking Wellbutrin SR 150mg in the morning and at 3 pm; Serzone 150mg in morning and around 9 p.m.

My pdoc says my depression is chronic and treatment resistant. He thinks I have had depression since childhood (I am 40). When I was diagnosed, my life was going downhill (marriage breaking up; alcoholic mother's health declining). I was referred to my psychiatrist by a university sleep clinic because I was complaining of insomnia. Six mos. later, separation and mom's death happened within 2 weeks of each other July '98). With much help from my psychiatrist, who sees me weekly because he also is my psychotherapist, I have gotten better. In January, I made major changes in my life (quit a well-paying job as a department manager and went back to college for a master's that I hope I can combine with current skills and go in another direction). I had not felt this happy and positive in 10-15 years.

A few weeks before Easter, I started feeling weepy, sad, more lately despairing. I suspect it has to do with holidays and not having family, and increased work at school as the semester comes to a close. My doctor gave me
Ativan for times when the anxiety starts to impair my thinking. My doctor seems to think these feelings are normal. The last few days, I have been having trouble just getting through the day.

I apologize for such a long message. My question: is it possible to ever find the right combination of drugs/lifestyle, etc. so that depression such as this will go away for long lengths of time or maybe even permanently? (I have given up the notion of ever getting off ADs.) I visit this board periodically (especially when I start feeling bad). Of course, there aren't many stories of total success; everyone here is looking for some sort of relief. For the usual reasons, outside of this board I say little or nothing about my depression. Consequently, I don't know anyone who has overcome depression after many years. Do they exist?

Thank you very much for your time.

 

Dr Kramer - I have the same question

Posted by mair on April 3, 2002, at 8:21:03

In reply to Kramer: does depression ever stay in remission?, posted by allisonm on April 3, 2002, at 7:41:57

I can't say that I've ever reached quite as enduring a stage of remission as Allison, but my profile is not dissimilar and I might be where she has been if I made the major kind of lifestyle change that she did.

I too know and accept that I'm on the ADs for life plan, but what I don't really understand is what chronic, somewhat treatment resistant depression means in terms of an anticipated quality of life. Is a lasting remission possible, or is it more likely that people such as us will always face intermittent bouts of major depression, perhaps in spite of positive lifestyle changes we might make?

Thanks

Mair

 

Re: Dr Kramer - I have the same question

Posted by Emme on April 3, 2002, at 10:30:23

In reply to Dr Kramer - I have the same question, posted by mair on April 3, 2002, at 8:21:03

Hi. I don't know what Dr. Kramer will be able to tell you from his broad clinical experience. But I do know two people who seem to have reached a state of long term remission after going through hell. One is happy to be on prozac forever - she feels good. The other, amazingly, was doing fine without medicine last time I talked to him. Although I think he'd be okay with being on medicine long term if he needed it. Oh, and there's a third. He's had some bumps and needed to change meds, but I don't think he ever got as bad again as his first bout.

cheers,
Emme

 

Re: Kramer: does depression ever stay in remission?

Posted by crepuscular on April 3, 2002, at 11:43:34

In reply to Kramer: does depression ever stay in remission?, posted by allisonm on April 3, 2002, at 7:41:57

hi allison,

i would probably put myself in a similar category as you, except that i have a bipolar form of this disease. i've concluded that i'll always have to be vigilant about my moods. i've had periods of remission that last several years, but then the beast comes back. sometimes this is my own fault - i go off meds (because of side fx, hubris, etc.) but sometimes it's just the condition itself.

but the reality for me - and i'm suggesting it may be the same for you - is that this is a life long medical condition that you simply have to *fight* like cancer, diabetes, or whatever.

a close friend of mine has lupus and she will do fine for a year or two, and then boom, another attack will begin. she's on her 3rd kidney transplant now. somehow, she battles through these episodes, does the best she can, and accepts the disease-free periods as a gift. maybe depression is like this - a chronic, episodic condition. if it is, then gear up for a protracted battle.

i think we can pummel depression down to a certain size, but it will never go away forever. and then there is the secondary damage from simply being depressed - knowing what it's like to consider suicide, spending a year as a ghost in your own body, not sleeping or over sleeping, etc. it's hard to believe, but most people never have severe mental health symptoms like this.

my tactic these days is this: Do what you need to do *before* you need to do it. that is, avoid having relapses at all costs. the more time we spend in a depressed state, the more our brains seem to want to go there. i think depression is damaging to our brains. so take those meds, switch if they aren't working, exercise daily, take reasonable doses of supplements, practice good sleep habits, recognize your vulnerability to life stressors.

 

Re: Kramer: does depression ever stay in remission?

Posted by Dr. Kramer on April 4, 2002, at 13:13:45

In reply to Kramer: does depression ever stay in remission?, posted by allisonm on April 3, 2002, at 7:41:57

Yes, actually we are pretty good at treating depression. The problem is that it often takes a long time to find the right drug or combination of drugs. We have lots of good drugs (and more in development) but not any good ways of matching them up to a particular patient. All we can do is keep trying. I agree with your doc that you would be considered Treatment refractory, which just means that it will take more tries with combinations to get to the right one. But we do.

Be well.

 

Re: Dr Kramer - I have the same question

Posted by Dr. Kramer on April 4, 2002, at 13:18:59

In reply to Dr Kramer - I have the same question, posted by mair on April 3, 2002, at 8:21:03

> I can't say that I've ever reached quite as enduring a stage of remission as Allison, but my profile is not dissimilar and I might be where she has been if I made the major kind of lifestyle change that she did.
>
> I too know and accept that I'm on the ADs for life plan, but what I don't really understand is what chronic, somewhat treatment resistant depression means in terms of an anticipated quality of life. Is a lasting remission possible, or is it more likely that people such as us will always face intermittent bouts of major depression, perhaps in spite of positive lifestyle changes we might make?
>
> Thanks
>
> Mair

To add to what I said to Allison:

To a certain extent all depression is chronic and recurrent. You may only get one or two episiodes in a life, or many more, but it's not like an infection for which you can kill all the bacteria and be done with it. You always have the vulnerablity to it. On the other hand, there so many good treatments that that I believe the quality of life for sufferers will continue to improve.

 

Re: Dr Kramer - ECT for the med weary?

Posted by Mags on April 4, 2002, at 23:36:29

In reply to Re: Dr Kramer - I have the same question, posted by Dr. Kramer on April 4, 2002, at 13:18:59

Hi Dr. Kramer and everyone else..

I am VERY VERY low right now...quit all my meds in anticipation of ECT starting April 14..I am counting the days....i guess the Lamictal was doin' somethin 'cause I am way low without it....that feelin where you are walking through sludge and your feet are 2 feet below the surface...anyone ever felt that way..plus I couldn't stop crying over a stupid Canadian Tire commercial...everyone look so normal, happy, energised....

I was just wondering what your thoughts, experience's have been with ECT...do many have to do maintenance ECT or what meds worked that didn't before etc. I am dx'd BPII and very treatment resistant and very med sensitive, can you share your thoughts??

Anyone else out there had it done yet????.....I am very low today..perhaps I may have to go in to hospital a week early.....
Mags
sorry to go on so much....


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