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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 42. This is the beginning of the thread.
Posted by Silly Brain on September 17, 2002, at 15:43:36
I would like to know if anyone else has a similar history to mine, and what worked for them.I have had many recurrent major depressive epidoses since adolescence. Usually they end in 2-3 months. This one has been going strong for 18 months. I have many ADD symptoms as well. I was misdiagnosed with Bipolar II when Zoloft made me hypomanic. I have tried:
Prozac - made me numb, spacey, stomach achey.
Zoloft - made me agitated, deleted sex drive.
Paxil - felt not a thing
Depakote - no one told me that it raises the hormone levels of whatever birth control pill you're taking. I was EXTREMELY SUICIDALLY DEPRESSED. I would cry for no reason in public places. My period did not come even on when on the placebo week - my hormone levels were that high. It did nothing else besides make me hungry and miserable.
Serzone - have been on this the longest (one year). I am still severely depressed. I'm worried I might be more so without it, but it's certainly not adequete.
Dexedrine Spansule - after one week, all novelty wore off. Doesn't seem to do much.
Now what? Wellbutrin? Effexor? added to Serzone or instead of? I won't touch Remeron - I still haven't lost the weight I gained on Depakote.
For those wondering "why don't you ask your shrink" it's because he's a school shrink who doesn't seem terribly interested in me other than to write a script. I called literally a dozen doctors this summer who are in my PPO and they said they weren't taking new patients. I'm losing my ability to function, had to cut work hours, etc. It's getting very frightening.
I talked to a sleep doc this week who thinks I may have sleep apnea, which might be causing or exacerbating the depression and ADD symptoms. Wouldn't that be a kicker.
Silly
Posted by Eddie Sylvano on September 17, 2002, at 15:54:26
In reply to Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 15:43:36
You could always try a tricyclic antidepressant (amitryptiline, imipramine, etc) instead of an SSRI. Most of the literature descibes them as the "gold standard" of antidepressive medications. They have some bothersome side effects, but if you're that incapacitated, it might be worth a try.
Posted by Silly Brain on September 17, 2002, at 18:59:26
In reply to Re: Unresponsive to SSRIs? What worked?, posted by Eddie Sylvano on September 17, 2002, at 15:54:26
Thanks for the suggestion, but there's no way I'm taking something that causes weight gain, dry mouth, constipation, etc, in nearly all people who take it.
I'm specifically looking for people who have also been unresponsive to (or had too many side effects from) SSRI's, and what meds worked for them.
Thanks,
Silly
Posted by BrittPark on September 17, 2002, at 21:52:23
In reply to Re: Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 18:59:26
> Thanks for the suggestion, but there's no way I'm taking something that causes weight gain, dry mouth, constipation, etc, in nearly all people who take it.
TCA's get an undeservedly bad rap. Most people who take them lose most of the side-effects with time. However, since you don't like the idea of TCA's why not try effexor which has a NE/Serotonin profile quite like a TCA but with fewer side effects (for most people). If a trial of Effexor doesn't work reconsider a TCA.
>
> I'm specifically looking for people who have also been unresponsive to (or had too many side effects from) SSRI's, and what meds worked for them.
>
> Thanks,
> SillyDon't worry too much you'll find something that works. It just sometimes takes some trial and error.
Get Better,
Britt
Posted by Silly Brain on September 17, 2002, at 23:13:10
In reply to Re: Unresponsive to SSRIs? What worked?, posted by BrittPark on September 17, 2002, at 21:52:23
Thanks, Britt.
I have thought of Effexor, though a bit cautiously because of the horror stories about withdrawals. I also didn't realize that TCAs lost their side effects.
I'm nearing the idea of throwing in the towel and seeking psychotherapy to the exclusion of medications.
Silly
Posted by oracle on September 18, 2002, at 1:01:30
In reply to Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 15:43:36
The answer is simple, at least it was for me.
5HT is not the issue if none of the SSRI's work.
Try meds that effect NE. ADD points to NE involvement.If you have sig. depression, SSRI's have never been front line meds. Do follow up on the
sleep apnea.For me, I reached the point where I stopped playing the game of "I want to get well but will not take X" and that is when I started getting well. Thin but wanting to kill myself and being unable to leave the house did not cut it.
Posted by viridis on September 18, 2002, at 2:22:29
In reply to Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 15:43:36
I had severe, recurring depression (several times a year for over 25 years), coupled with, and probably caused largely by, repeated bouts of major anxiety. I've also been diagnosed with mild to moderate ADD. I took Prozac on and off for years (at various dosages), and each time, it caused intense anxiety at first, followed by a wired yet detached feeling of no emotion or interest in life. Zoloft triggered bizarre, uncontrollable mood swings even at very low doses. Wellbutrin (not an SSRI) improved my mood a bit but made the anxiety unbearable, and had various other intolerable side effects.
I was pretty discouraged, but a little over a year ago I saw a new psychiatrist who quickly identified me as a poor candidate for SSRI therapy. He initially prescribed Klonopin daily and Xanax as needed. That immediately reduced my anxiety and things started to get better. I still had depressive episodes, but they were much milder and more manageable. Then we added Neurontin, and that may have helped a bit more. With the anxiety and mood swings under control, the next successful addition was low-dose Adderall, which alleviated many of the ADD symptoms and took care of the remaining depression. We tried other things along the way (e.g., Provigil) but when they caused side effects or weren't helpful, my pdoc moved on to other options.
This combo (Klonopin/Adderall/Neurontin, plus occasional Xanax) seems to work well for me so far, and I haven't needed any dosage increases. This is the first year that I can remember in which I've been essentially free of major depression and severe anxiety. I'm much more consistently productive than before, my moods are stable, and I'm actually enjoying life.
Of course, this wouldn't be the ideal mix for everyone, but it does show that there are lots of options. Many doctors don't know what they're doing -- for example, my GP insists that any side effects from modern antidepressants must be "imaginary" because these drugs don't cause side effects (!!!). You may have to hunt around to find an understanding doctor (probably a psychiatrist/psychopharmacologist would be best), but they do exist.
By the way, some people on this board do very well with Lamictal, which apparently has antidepressant as well as mood-stabilizing qualities. I've never tried it, but have a close friend who has benefited greatly from Lamictal for depression and bipolar issues. That's just another of the many non-SSRI options to discuss with a qualified pdoc.
Posted by Silly Brain on September 19, 2002, at 0:16:55
In reply to Re: Unresponsive to SSRIs? What worked?, posted by oracle on September 18, 2002, at 1:01:30
> The answer is simple, at least it was for me.
> 5HT is not the issue if none of the SSRI's work. > Try meds that effect NE. ADD points to NE involvement.Indeed today I was prescribed Wellbutrin which apparently affects NE.
> If you have sig. depression, SSRI's have
> never been front line meds.Oh that's an interesting piece of info. Makes me kind mad, too, since I've been significantly depressed for a long time and keep getting SSRIs thrown at me.
> Do follow up on the > sleep apnea.
I think it may just be ongoing insomnia, personally, which certainly doesn't help. I felt significantly better today than in the past few days and the only difference has been more sleep.
> For me, I reached the point where I stopped > playing the game of "I want to get well but > will not take X" and that is when I started > getting well. Thin but wanting to kill myself and > being unable to leave the house did not cut > it.There was a time when I was playing the "just prescribe me anything I'll take it" game, which proved rather miserable as well.
Thanks for your help,
Silly
Posted by Silly Brain on September 19, 2002, at 0:43:53
In reply to Re: Unresponsive to SSRIs? What worked?, posted by viridis on September 18, 2002, at 2:22:29
Viridis, thanks for sharing your experience! Your Prozac and Zoloft experience sounded a lot like mine. I have less anxiety, though. I wouldn't think Klonopin and Adderral would work together, but shows what I know!
Thanks for sharing your success story with me. It really helps.
Posted by oracle on September 19, 2002, at 1:31:15
In reply to Re: Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 19, 2002, at 0:16:55
> There was a time when I was playing the "just prescribe me anything I'll take it" game, which proved rather miserable as well.
>
> Thanks for your help,
> Silly
There is no way to know what med will have what side effect and you can choose to stop ones that have effects you cannot put up with. I would not go so far to take anything, some meds by default
have unexceptable side effects that could exist after long after treatment has stopped. For myself I would never take AP's, in the context of treatment for depression.In terms of NE (NE agents are the only ones that work for me) the choices are Effexor above 150 mgs, Remeron, The TCA's (Tofranil, Doxepin, Sumontril) MAOI's, and Wellby. The info on Wellby is conflicting and it did nothing for me. This list would be in the order of my preferance.
One cannot effect NE without the possibility for
heart issues. Raised BP or changed EKG with TCA's.BP is managable and the EKG changes, if their are any, are generally of no consern.
This only becomes an issue with existing heart problems. So just get your BP checked and EKG, all part of a normal physical exam. Raised BP
is more common with Effexor and MAOI's.
Posted by delna on September 19, 2002, at 3:16:10
In reply to Re: Unresponsive to SSRIs? What worked?, posted by oracle on September 19, 2002, at 1:31:15
i have tried prozac, paxil, celexa, lithium, valproate and the tca's plus many more. i have had depression since i was 11 and i am actually diaganosed with bipolar.
the ssris helped me a bit but i was still unable to lead a normal life- i was apathetic and still had many symptoms.
for me effexor really worked. i was up and about and even held down a job. my doc says that effexor really helps thoes with add as well, which i suffer from. withdrawal is hard but it is possible if u do it slowly. i think it may be worth a try
good luck
Posted by Silly Brain on September 19, 2002, at 3:36:16
In reply to Re: Unresponsive to SSRIs? What worked?, posted by oracle on September 19, 2002, at 1:31:15
> In terms of NE (NE agents are the only ones > that work for me) the choices are Effexor above 150 mgs, Remeron, The TCA's (Tofranil, Doxepin, Sumontril) MAOI's, and Wellby. The info on Wellby is conflicting and it did nothing for me. This list would be in the order of my preferance.I find that interesting. It was my understanding that Effexor hit 5HT and NE and Wellbutrin hit NE and dopamine. It seems that you're saying that Effexor hits NE harder than Wellbutrin?
Thanks,
Silly
Posted by oracle on September 19, 2002, at 9:50:38
In reply to Re: Unresponsive to SSRIs? What worked? » oracle, posted by Silly Brain on September 19, 2002, at 3:36:16
> I find that interesting. It was my understanding that Effexor hit 5HT and NE and Wellbutrin hit NE and dopamine. It seems that you're saying that Effexor hits NE harder than Wellbutrin?
>
> Thanks,
> SillyIgnore dopamine, unless you are taking an AP. AD's that list action with dopamine don't really have much, or one would get TD, EPS and other nasty effects.
The judy for me is still out on Wellby and NE. Action is there but I think it is much. In Effexor, and doses under 150 mgs, it is the most powerful 5HT agent we have, above 150 it becomes a powerful NE agent.At 300-450 it is the most powerful NE agent I have taken.
Posted by Silly Brain on September 19, 2002, at 13:05:53
In reply to Re: Unresponsive to SSRIs? What worked?, posted by oracle on September 19, 2002, at 9:50:38
> Ignore dopamine, unless you are taking an AP. AD's that list action with dopamine don't really have much, or one would get TD, EPS and other nasty effects.I'm not sure I understand. Dopamine is affected by stimulants/amphetamines, such as ritalin, dexedrine, adderall...and before they were given to hyper kids for focus they were given to depressed housewives for lack of motivation. In fact, an ad from the 60s refers to Dexedrine Spansule as the model antidepressent. That's far from the AP effects on dopamine, but still dopamine stimulating all the same. My understanding is that Wellbutrin has somewhat less stimulating effects on dopamine than amphetamines.
http://amphetamines.com/dexedrine.html
> The judy for me is still out on Wellby and NE. Action is there but I think it is much. In Effexor, and doses under 150 mgs, it is the most powerful 5HT agent we have, above 150 it becomes a powerful NE agent.At 300-450 it is the most powerful NE agent I have taken.
How do you know you are getting an NE effect as opposed to a 5HT effect? One speculation I heard is that SSRIs make people more resilient and tolerant of stress, but this doesn't really address the darkness and demotivation of depression.
Thanks,
Silly
Posted by Silly Brain on September 19, 2002, at 13:07:37
In reply to Re: Unresponsive to SSRIs? What worked?, posted by delna on September 19, 2002, at 3:16:10
Thanks for sharing this experience with me! May I ask what dosages of Effexor was effective for you?
Thanks,
Silly> i have tried prozac, paxil, celexa, lithium, valproate and the tca's plus many more. i have had depression since i was 11 and i am actually diaganosed with bipolar.
> the ssris helped me a bit but i was still unable to lead a normal life- i was apathetic and still had many symptoms.
> for me effexor really worked. i was up and about and even held down a job. my doc says that effexor really helps thoes with add as well, which i suffer from. withdrawal is hard but it is possible if u do it slowly. i think it may be worth a try
> good luck
Posted by oracle on September 19, 2002, at 15:59:19
In reply to Re: Unresponsive to SSRIs? What worked? » oracle, posted by Silly Brain on September 19, 2002, at 13:05:53
> I'm not sure I understand. Dopamine is affected by stimulants/amphetamines, such as ritalin, dexedrine, adderall...and before they were given to hyper kids for focus they were given to depressed housewives for lack of motivation.
motivation=NE
In fact, an ad from the 60s refers to Dexedrine Spansule as the model antidepressent. That's far from the AP effects on dopamine, but still dopamine stimulating all the same. My understanding is that Wellbutrin has somewhat less stimulating effects on dopamine than amphetamines.
All amphetimines highly effect NE.
If dopamine was highly effected
ones would expect AP like effects.
Also it does seem that pleaying with dopamine
can has neast effects.> How do you know you are getting an NE effect as opposed to a 5HT effect?
Prozac at high dose, nothing
Zoloft, nothing
Any SSRI, nothing
TCA's that have a lessor effect on NE are less effective for me.
Posted by Silly Brain on September 19, 2002, at 18:00:38
In reply to Re: Unresponsive to SSRIs? What worked? » oracle, posted by oracle on September 19, 2002, at 15:59:19
> > I'm not sure I understand. Dopamine is affected by stimulants/amphetamines, such as ritalin, dexedrine, adderall...and before they were given to hyper kids for focus they were given to depressed housewives for lack of motivation.
>
> motivation=NE> All amphetimines highly effect NE.
> If dopamine was highly effected
> ones would expect AP like effects.
> Also it does seem that pleaying with dopamine
> can has neast effects.So you're saying that what I've read about amphetamines,
dopamine, and motivation is false. Okay. Sources?Amphetamines in high doses do in fact cause psychosis - this
is what too much cocaine or crank or crystal does. And snorting
lots of ritalin, which people have done. So if you are right
that dopamine is related to psychosis, this still doesn't mean
that amphetamines don't affect dopamine.
> > How do you know you are getting an NE effect as opposed to a 5HT effect?
>
> Prozac at high dose, nothing
> Zoloft, nothing
> Any SSRI, nothing
> TCA's that have a lessor effect on NE are less effective for me.Perhaps my questions was not clear. How do you know it wasn't the
serotonin enhancement from Effexor that helped you? It affects serotonin
differently, and perhaps that mechanism was more helpful than the SSRI
mechanism.What is the difference between a serotonin boost and a NE boost, experientially.
You're claiming that the difference between these is that 5HT boost does nothing,
and NE stops depression. This doesn't explain the people getting help from SSRIs.Silly
Posted by Mystia on September 19, 2002, at 22:50:40
In reply to Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 15:43:36
I have the opposite problem: I am super-sensitive to meds. Everything I have tried up to this point has NOT been good for me. I have just come to the conclusion that it's just a trial-and-error process. I am okay with that, just as long as I don't run across anything else that gives me abnormal heart rate like Serzone did!
One thing I have found helpful is to start a journal. When I start a new med, I start a journal and keep a record of how I feel and s/e. When I go back to see the doc, I bring it with me so I can tell him what's going on. It probably saved my life in one situation. The doctor picked up on the signals after I read him some journal entries and I was sent immediately to the ER, where I was told I had heart palpitations. SO, the journal can be a great tool.
Good luck in your search for the right med for you!
Myst
Posted by viridis on September 20, 2002, at 0:09:49
In reply to Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 15:43:36
Hi Silly B,
One other piece of advice: you said you're in a PPO. This is generally good -- it usually means that you're paying extra, and have your choice of doctors. You said you called a dozen, and they weren't accepting new patients. So, call a dozen more (if possible).
I don't know where you are, but one thing I do know (from my pdoc) is that pychiatrists have some of the highest cancellation rates of any doctors. It took me over a month to get in to see my pdoc the 1st time, but since then he's told me that if I ever have a crisis, he can always get me in within a day, because so many patients cancel or don't show up. I also know (from experience) that if you firmly and reasonably present your situation as critical, they can get you in fast, even for a 1st visit.
When you're depressed, it can be very hard to push things, but sometimes you just have to force yourself to be aggressive. You need the help, and there really are experts who can provide it, often much faster than they initially let on.
Posted by totoslim on September 20, 2002, at 11:17:30
In reply to Re: Unresponsive to SSRIs? What worked?, posted by BrittPark on September 17, 2002, at 21:52:23
Moclobemide is the only try >
Aurorix, Mocloxil- no sexual side effects no weight gain, only insomnia possible for the first few weeks. Acts very quickly.
Or try to add zyprexa 5 mg to SSRI
Posted by delna on September 20, 2002, at 12:15:48
In reply to Re: Unresponsive to SSRIs? What worked? » delna, posted by Silly Brain on September 19, 2002, at 13:07:37
> Thanks for sharing this experience with me! May I ask what dosages of Effexor was effective for you?
>
> Thanks,
> Silly
>
1 was on 300mg. that made me very alert and focused but sometimes a bit hypomanic. anyway i am restarting it and aiming at 150mg. also this time my doc is adding wellbutrin 150-300mg to add a 'pep'. effexor took care of my psychotic depression, ocd and extreme exhaustion though i put on weight and sweated alot.which 4 me is a small price to pay. for me the ssri's do nothing for my mood- just ocd.
hopefully at the lower dose of 150 effexor will be better.
Posted by cybercafe on September 20, 2002, at 13:45:43
In reply to Re: Unresponsive to SSRIs? What worked? » oracle, posted by oracle on September 19, 2002, at 15:59:19
> > I'm not sure I understand. Dopamine is affected by stimulants/amphetamines, such as ritalin, dexedrine, adderall...and before they were given to hyper kids for focus they were given to depressed housewives for lack of motivation.
>
> motivation=NEI don't think motivation is linked to anyone one brain chemical as it is a general term
for example, i believe i read once that "dopamine is responsible for the initiation of behaviours, norepenephrine is responsible for the continuation of behaviours, and serotonin is responsible for mood" ....
i know the nucleus accumbens is supposed to be responsible for reward, and it is effected by dopamine, serotonin, and norepenephrine ... though mostly dopamine, it would seem ... i mean we all know that different serotonin receptors have different effects on dopamine neurons (inhibitory or excitory) for example, 5HT2A receptors have an inhibitory effect on dopamine neurons in the nucleus accumbens
i also believe the emotion of "joy" is related to the globus pallidus, which is believed to be a dopamine-rich area...
Posted by dave40252 on September 20, 2002, at 13:47:35
In reply to Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 15:43:36
All can say is keep trying. Eventually you are likely to find something or a combination of things that will work for you. Since i started treatment i have been on zoloft, effexor, remeron, welbutrin, serzone, nortryptiline(sp?) celexa, prozac and ritalin and varous combinations of the above. Some worked a little, some worked pretty good but had bad side effects. I am now on a combo of prozac 20mg/day, wellbutin
250mgs/day and ritalin 20mg twice a day. It took a lot of trial and error but this combo has been working real well for me, with little in the way of side effects. I can get my self to work, actually get something done, i am able to socialize without feeling completely cut off from people, and my mood has been good. its been going that way for over a month now and i am starting to believe it might last! Hang in there.
Posted by Silly Brain on September 20, 2002, at 14:14:56
In reply to Re: Unresponsive to SSRIs? What worked?, posted by dave40252 on September 20, 2002, at 13:47:35
You know what? I can't see how this is any different than taking a bunch of recreational drugs until you find what makes you happy.
And I can't see how it's any different that obliterating out your pain with street drugs rather than dealing with your pain.
The world SUCKS right now. I've never been so appalled by the actions of my government, I can't find a job in my field, my relationship is not exactly fulfilling, I have a chronic illness I can barely afford to treat, and I don't have time to exercise and my body looks like crap. It is entirely SANE for me to hate life right now.
A drug is going to fix these things? This is absurd. I don't know why I'm bothering.
Silly, Angry, Brain
Posted by ayrity on September 21, 2002, at 0:48:04
In reply to Moclobemidum is the only shot!!!!!!!!, posted by totoslim on September 20, 2002, at 11:17:30
It's a good idea to try Moclobemide first in the MAOI due to lack of side effects or dietary restrictions. However, sorry, it might work for some people but it did nothing for me, and I gave it a good try. Now I'm on a regular MAOI (Parnate)- the jury's still out on this one.
> Moclobemide is the only try >
> Aurorix, Mocloxil- no sexual side effects no weight gain, only insomnia possible for the first few weeks. Acts very quickly.
> Or try to add zyprexa 5 mg to SSRI
>
> http://www.strony.wp.pl/wp/hen13
>
> http://www.moclobemide.info/moclobemide/moclobemide-10.htm
>
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