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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 42. Go back in thread:
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
>
Posted by viridis on September 21, 2002, at 1:19:24
In reply to Re: Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 20, 2002, at 14:14:56
Hi again Silly B,
When you're depressed, everything seems negative, so I'm not surprised that things seem so bleak to you. I've been there dozens (probably hundreds) of times. But good psychiatric treatment is different from using street drugs in several ways.
First of all, you actually know what you're getting (whether it works for you or not).
Second, you have expert advice to help you choose the appropriate medication(s). Of course, you have to be persistent in finding an expert who understands your condition, but if you look hard enough you'll find one.
Third, the goal with psychiatric drugs isn't to get high, or obliterate yourself or your true personality, it's just to feel normal. This really is possible, but it will almost certainly take some trial and error.
There's a huge range of options available, and they may seem overwhelming. But you can find a solution that will allow you to enjoy life without intolerable side effects. It's really hard when everything seems so hopeless, but you have to keep trying. I nearly gave up on various occasions, but I finally found a combination that (so far at least) works very well.
The fact that you're seeking advice here indicates that you really want to get well, and you can. It may take a huge push on your part to get there -- and this is very difficult when you feel so miserable -- but you owe it to yourself to make the effort. It's worth it when you finally succeed. Also, it's good that you're angry instead of complacent. Why shouldn't you be angry? It's unfair that you have this illness, but great that you want to fight it.
I know this probably sounds like a bunch of platitudes, but it's the truth. I know that, and so do many others here who are trying to help. Don't give up, and don't let the depression take over and falsely convince you that your situation is hopeless, because it isn't.
Posted by cybercafe on September 21, 2002, at 4:59:59
In reply to Re: Moclobemidum is the only shot!!!!!!!!, posted by ayrity on September 21, 2002, at 0:48:04
> 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.
how high did you take the moclobemide dose before giving up?
Posted by dave40252 on September 21, 2002, at 11:05:19
In reply to Re: Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 20, 2002, at 14:14:56
> 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.
well, that is true only to a small extent. - see the post from viridis - but even to the extent it is true, i really don't care much. With the meds i am starting to lead a normal life. If my choice is to take meds or be miserable - I'll take teh meds.
> And I can't see how it's any different that obliterating out your pain with street drugs rather than dealing with your pain.which assumes that there is some way you CAN deal with it and make it go away. I couldn't.
> 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.
No a drug won't "fix" all those things - but they can make you well enough that you stop blaming others for your misery and see that you can improve your life, that there is hope, that you can feel good.
been there, done that. may do it again.
Posted by URCONFUSED on September 21, 2002, at 17:01:56
In reply to Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 15:43:36
Stop killing yourself with this silly medication merry go round and give ECT a good shot. It almost always works and has few side effects as long as its done properly. Its effective for bipolar as it is for depression.
URCONFUSED
Posted by Phil on September 21, 2002, at 20:39:56
In reply to Re: only thing that will work is ECT, posted by URCONFUSED on September 21, 2002, at 17:01:56
When did you have ECT, UR?
Posted by Silly Brain on September 22, 2002, at 1:31:23
In reply to Re: Unresponsive to SSRIs? What worked?, posted by dave40252 on September 21, 2002, at 11:05:19
> No a drug won't "fix" all those things - but they can make you well enough that you stop blaming others for your misery and see that you can improve your life, that there is hope, that you can feel good.
Uh...blame others for my misery? Jesus Christ are you off-base.
Refusing to see shrinks because I am sick of being jerked around and wanting to "pull myself together" and "get it right" is the complete opposite of blaming others. How is blaming your body chemistry any different?
Silly
Posted by Silly Brain on September 22, 2002, at 1:37:58
In reply to Re: Unresponsive to SSRIs? What worked?, posted by viridis on September 21, 2002, at 1:19:24
> Hi again Silly B,
>
> When you're depressed, everything seems negative, so I'm not surprised that things seem so bleak to you. I've been there dozens (probably hundreds) of times. But good psychiatric treatment is different from using street drugs in several ways.
>
> First of all, you actually know what you're getting (whether it works for you or not).I'll agree with you there.
> Second, you have expert advice to help you choose the appropriate medication(s). Of course, you have to be persistent in finding an expert who understands your condition, but if you look hard enough you'll find one.That's just bullshit in my case. Guess what I found out today? I work in a hospital, and I was reading the nurse's guide to drugs, and looked up Serzone, which I've been on for a year. My doctor told me to take two pills once a day rather than one twice day - that it didn't matter. It damn well does matter! I confirmed this with a pharmacist and looked it up in the PDR. Serzone only has a half life of 2-4 hours! I'm SO MAD! In 10 hours, it's gone from your body and I'm taking it every 24! That MORON!
> Third, the goal with psychiatric drugs isn't to get high, or obliterate yourself or your true personality, it's just to feel normal.
I agree.
> This really is possible, but it will almost certainly take some trial and error.
I'm losing faith in the possibility. Definiltey losing patience.
> There's a huge range of options available, and they may seem overwhelming. But you can find a solution that will allow you to enjoy life without intolerable side effects. It's really hard when everything seems so hopeless, but you have to keep trying. I nearly gave up on various occasions, but I finally found a combination that (so far at least) works very well.
I can only hope I can acheive the same. I cannot tell you how MUCH I've been trying to get real treatment and how much I've been getting crap instead.
> The fact that you're seeking advice here indicates that you really want to get well, and you can. It may take a huge push on your part to get there -- and this is very difficult when you feel so miserable -- but you owe it to yourself to make the effort. It's worth it when you finally succeed. Also, it's good that you're angry instead of complacent. Why shouldn't you be angry? It's unfair that you have this illness, but great that you want to fight it.This is what pisses me off - why can't shrinks do their jobs? Why the hell do I have to do it for them? This is what makes them little different than drug pushers. I say I feel like crap. They say "Try this" and they only vaguely know what it is or what it will do to me.
> Don't give up, and don't let the depression > take over and falsely convince you that your > situation is hopeless, because it isn't.
Thank you for your support. Though I really think that if I could do that, then I don't need meds, do I? And I think I can do that, you understand. I think that self-reliance is a much better hope than drugs at this point.
Silly
Posted by ayrity on September 22, 2002, at 2:16:29
In reply to Re: Moclobemidum is the only shot!!!!!!!!, posted by cybercafe on September 21, 2002, at 4:59:59
Hi cyber!
Sorry, I don't remember the details of the Moclobemide, it was a while ago. I'll try to find out next time I'm at the doc. I remember we gave it a good long trial and did increase the dose, but I don't remember how much.
> how high did you take the moclobemide dose before giving up?
Posted by viridis on September 22, 2002, at 4:06:10
In reply to Re: Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 22, 2002, at 1:37:58
Hi Silly B,
Your attitude is a lot like mine was for years. It's amazing how inept some doctors can be. I could tell you so many stories ... like the doctor who told me that modern antidepressants either work or have no effect at all, period. He prescribed Wellbutrin, starting at triple the normal, beginning therapeutic dose. When I questioned this (since I'd researched it a bit beforehand), he said don't worry, it would be fine. Luckily, the pharmacist didn't think so, and checked with the doctor, who then said he'd accidentally written the wrong dosage on the prescription. When I reported ongoing, serious side effects with it (at a standard dose for 2 months), the doctor said this wasn't possible, and that I must be imagining them (I'm not sure how I could "imagine" physical and mental feelings I've never had before). SSRIs were awful for me, but various doctors just kept pushing them anyway, until I finally just refused SSRI treatment.
I could go on, but you get the point -- there are a lot of incompetent doctors out there. I got lucky with my current pdoc (who, by the way, said Wellbutrin would be just about the last thing he'd prescribe, given my situation). But it wasn't really just luck -- it was also perseverance, after a string of inappropriate treatments and misguided doctors.
It hardly sounds like you've exhausted the possibilities (although I'm sure you're exhausted!). Maybe you can get through this without medication, but I doubt it -- at least, not in the sense of achieving lasting relief. If you've had long-term, serious depression, then the chances are it will continue and/or recur without drug treatment. And, the chances are that there will be treatments out there (not necessarily SSRI) that really work.
All I can say is, keep seeing different doctors (ideally psychiatrists or psychopharmacologists), and go in armed with knowledge of the available medications, their properties, and what you suspect might be appropriate for you. Try not to act too pushy or seem like a know-it-all, but be firm and show that you have some idea of how these things work. Be open to their suggestions, but if you encounter a doctor who dismisses your ideas, insists that only one specific drug will work, or ignores a negative reaction to a particular treatment, then move on.
This takes a lot of energy (very hard when you're depressed), but it sounds like you have many things on your side. You work in a medical setting, so you have access to information and probably have a better understanding of medicine than the average person. You won't put up with nonsense from inept doctors, and you sound like you're better equipped than most to spot the bad ones and not waste too much time with them. And, you've obviously got drive that's just being drained by this illness. Why else would you be posting here and looking for help?
I wouldn't give up on pharmaceuticals yet if I were you, although I totally understand your frustration. Find a good doctor, and the chances are excellent that you'll get well. It may take some time, but what do you gain by giving up on treatment at this stage?
Posted by viridis on September 22, 2002, at 11:30:17
In reply to Re: Unresponsive to SSRIs? What worked?, posted by viridis on September 22, 2002, at 4:06:10
Just a couple of other things:
1) In the above post, I didn't mean to imply that Wellbutrin is an SSRI -- my point was that neither Wellbutrin nor the SSRIs I've tried were effective, and all had serious side effects, whereas treatment with the combo I'm on now has been very helpful.
2) One thing that hasn't been mentioned is psychotherapy. I don't know if you've tried this, but if you do decide to abandon the medication route, therapy can be helpful and might enable you to better formulate a life-change strategy. Therapy (traditional and cognitive behavioral) has helped me somewhat at times, but in the last two cases, the therapists wound up recommending that I seek drug treatment. Each felt that there was a major biological component to my depression and anxiety that required medication. One strongly recommended stimulants because he picked up a substantial ADD component to my problems. I was reluctant to pursue this for quite a while, but when my current pdoc suggested Adderall, I tried it and found it a big help (along with Klonopin and Neurontin).
Some credible research indicates that a combination of therapy and medication can be the best approach for some people, and a good therapist might be able to help you make some long-term treatment decisions even if they can't prescribe medications themselves.
Good luck!
Posted by Dr. Bob on September 22, 2002, at 12:58:43
In reply to Re: Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 22, 2002, at 1:31:23
> Jesus Christ are you off-base.
I'm sorry if you feel jerked around, but please remember that a goal of this site is support and don't post anything that could lead others to feel put down or use language that could offend others, thanks.
http://www.dr-bob.org/babble/faq.html#civil
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by Silly Brain on September 22, 2002, at 18:05:54
In reply to Re: please be civil » Silly Brain, posted by Dr. Bob on September 22, 2002, at 12:58:43
> > Jesus Christ are you off-base.
>
> I'm sorry if you feel jerked around, but please remember that a goal of this site is support and don't post anything that could lead others to feel put down or use language that could offend others, thanks.Dr. Bob -
I felt put down, so I defended myself by pointing out that the poster was off-base. Next time I'll leave out the expletive. Hopefully defending myself without expletives won't be considered "uncivil".
Silly
Posted by cybercafe on September 22, 2002, at 18:13:53
In reply to Re: Moclobemidum is the only shot!!!!!!!!, posted by ayrity on September 22, 2002, at 2:16:29
> Hi cyber!
> Sorry, I don't remember the details of the Moclobemide, it was a while ago. I'll try to find out next time I'm at the doc. I remember we gave it a good long trial and did increase the dose, but I don't remember how much.cheers
btw does moclobemide give the same agitation that parnate does?
Posted by dave40252 on September 23, 2002, at 12:17:39
In reply to Re: Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 22, 2002, at 1:31:23
Poor choice of words on my part - i am not presumtious enough to think i know anything about your situation - I didn't mean YOU when i said "you." I meant it generically. Actualy was describing myself, if anyone! The point of my post was simply that drugs will not fix everything that is wrong in someone's life, only that they CAN help -
>
> > No a drug won't "fix" all those things - but they can make you well enough that you stop blaming others for your misery and see that you can improve your life, that there is hope, that you can feel good.
>
> Uh...blame others for my misery? Jesus Christ are you off-base.
>
> Refusing to see shrinks because I am sick of being jerked around and wanting to "pull myself together" and "get it right" is the complete opposite of blaming others. How is blaming your body chemistry any different?
>
> Silly
Posted by Silly Brain on September 23, 2002, at 23:12:46
In reply to Re: Unresponsive to SSRIs? What worked?, posted by dave40252 on September 23, 2002, at 12:17:39
Ah. I understand. I apologize for taking it so personally. Unfortunately a big symptom of mine - interpreting ambiguity negatively.
Best,
Silly> Poor choice of words on my part - i am not presumtious enough to think i know anything about your situation - I didn't mean YOU when i said "you." I meant it generically. Actualy was describing myself, if anyone! The point of my post was simply that drugs will not fix everything that is wrong in someone's life, only that they CAN help -
> >
> > > No a drug won't "fix" all those things - but they can make you well enough that you stop blaming others for your misery and see that you can improve your life, that there is hope, that you can feel good.
> >
> > Uh...blame others for my misery? Jesus Christ are you off-base.
> >
> > Refusing to see shrinks because I am sick of being jerked around and wanting to "pull myself together" and "get it right" is the complete opposite of blaming others. How is blaming your body chemistry any different?
> >
> > Silly
>
>
Posted by Silly Brain on September 23, 2002, at 23:21:16
In reply to A couple of other quick points, posted by viridis on September 22, 2002, at 11:30:17
Viridis -
I want to thank you for both your posts. I think the dexedrine was making me short-tempered on top of everything. I'm already rather impatient. Adding depression to that makes me really obnoxious.
Well, I decided to stay on the Serzone, but to take it as it was designed to be taken - twice a day rather than one big dose at night. I've been doing this since Saturday and I already feel better. I think I might ask the doc to slightly increase the dose as well. I have *another* doc who prescribes the dexedrine, who suggested replacing it with Wellbutrin. I think I'll just lower the dex.
About psychotherapy... I've had many many experiences with therapy and liked very few of them. I seem to get one of two types: Either they think I am a very gifted, intelligent, fascinating person who is too hard on herself, which is nice, but not very useful, or they think I am a complete eccentric, arrogant, and unstable, and am basically a lost cause. Weird, huh? Truth is, I have an obvious philosophical/politcal slant, and if the shrink is in my same camp, likes me, but otherwise thinks I'm nutty. I wish the therapists who liked me would actually help me improve where I need to. Also, my brother commit suicide, and I believe extremely incompetent psychiatric treatment pushed him to it (long, sad, story), so I don't immediately trust anybody in psych.
Thanks for listening,
Silly> Just a couple of other things:
>
> 1) In the above post, I didn't mean to imply that Wellbutrin is an SSRI -- my point was that neither Wellbutrin nor the SSRIs I've tried were effective, and all had serious side effects, whereas treatment with the combo I'm on now has been very helpful.
>
> 2) One thing that hasn't been mentioned is psychotherapy. I don't know if you've tried this, but if you do decide to abandon the medication route, therapy can be helpful and might enable you to better formulate a life-change strategy. Therapy (traditional and cognitive behavioral) has helped me somewhat at times, but in the last two cases, the therapists wound up recommending that I seek drug treatment. Each felt that there was a major biological component to my depression and anxiety that required medication. One strongly recommended stimulants because he picked up a substantial ADD component to my problems. I was reluctant to pursue this for quite a while, but when my current pdoc suggested Adderall, I tried it and found it a big help (along with Klonopin and Neurontin).
>
> Some credible research indicates that a combination of therapy and medication can be the best approach for some people, and a good therapist might be able to help you make some long-term treatment decisions even if they can't prescribe medications themselves.
>
> Good luck!
Posted by Christina on September 25, 2002, at 10:01:13
In reply to Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 15:43:36
After trying several ADs and mood stabilizers over the past 7 years with minimal to moderate effectiveness, I am now taking 30 mgs of Adderall XR, and it is the best thing I've done. It helps me stay calm and is a mild mood enhancer.
When i was feeling depressed and irritable in the evenings after the Adderall wore off, My doc added Wellbutrin as well, but I'm not sure I want to stay in it. He suggested Serzone too, but I was afraid it would make me too tired.I'm trying to combat the evening moodiness with exercise and just doing other things to try and lift my mood. Sometimes it works, sometimes it doesn't.
By they way, before I tried Adderall, I tried Ritalin, which gave me a very negative "speeding" feeling. But everyone reacts differently to both ADs and stims.
With your reference to sleep apnea, you may want to try Provigil, but some have commented it wasn't affective for depression and/or ADD.
Good luck. It's a long road to even minimal recover, and a much longer one to actually start feeling good.
This is the end of the thread.
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