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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by DissTired on January 27, 2003, at 18:35:40
Hi,
I have atypical depression and used to get panic attacks. Desipramine helped for panic but not depression when I was younger. Then in my late 20s and early 30s parnate worked for me. I could only tolerate 20 mgs of parnate though, before my mind raced too much. Then in my early 30s, parnate just stopped working.
Since then I've tried just about everything. SSRIs and remeron did nothing or worse. Effexor worked for depression but made me feel lobotomized and tired (10 hours of sleep was a minimum requirement), and also seemed to make my mind perpetually cloudy, which is bad news for an academic.
My question is this. What other meds or med combos might work? Though SSRIs have not worked for me in the past, might Lexapro work?
Also, any news on whether Duloxetine has the same awful side-effects as effexor?
Thanks for any tips.
Posted by Jack Smith on January 27, 2003, at 19:35:52
In reply to atypical depression and antidepressants, posted by DissTired on January 27, 2003, at 18:35:40
Have you thought of wellbutrin? For many, it is quite energizing, so someone with AT depression might like it. Unfortunately, it seems to make me tired--go figure. Another suggestion would be nardil, if parnate worked before, it may be worth trying.
Have you given SSRI's an adequate trial at at "therapeutic dose." Also, you might want to try to augment an ssri with zyprexa--that would be a very ambitious move, however, some people though rave about the combo. If you have already not had success with Celexa, I would hold off on Lexapro and try some other things. . . .
Another thought is maybe you could go back on parnate, I have heard from several places that after a break from one drug that pooped out, it starts working again. Just a thought.
Jack
Posted by River1924 on January 28, 2003, at 2:22:03
In reply to Re: atypical depression and antidepressants, posted by Jack Smith on January 27, 2003, at 19:35:52
I have similiar symptoms to you. With SSRI's and TCA's, I always take concerta bid (for smooth stimulation) and klonipin (for anxiety.) The diet drug sibutramine is stimulating and is similiar to effexor but has more of a pick-me-up power. (I cannot mix sibutramine/wellbutrin/sibtramine with concerta...but that might be me.)
Lamictal at a high dose might work for your depression and anxiety. Looking back, I didn't go high enough. I should have taken 300mgs instead of 100mgs.
Vivactil is a stimulating TCA.
Right now I'm trying a complicated combo of Abilify, propanolol (for side effects and anxiety from Abilify), concerta, and klonipin.
Just some ideas.
My old stand by is stelazine and reminyl but I think my pdoc is the only one who'd let anyone try that.
Peace and Good Luck, Roger.
Posted by polarbear206 on January 28, 2003, at 16:44:42
In reply to atypical depression and antidepressants, posted by DissTired on January 27, 2003, at 18:35:40
> Hi,
>
> I have atypical depression and used to get panic attacks. Desipramine helped for panic but not depression when I was younger. Then in my late 20s and early 30s parnate worked for me. I could only tolerate 20 mgs of parnate though, before my mind raced too much. Then in my early 30s, parnate just stopped working.
>
> Since then I've tried just about everything. SSRIs and remeron did nothing or worse. Effexor worked for depression but made me feel lobotomized and tired (10 hours of sleep was a minimum requirement), and also seemed to make my mind perpetually cloudy, which is bad news for an academic.
>
> My question is this. What other meds or med combos might work? Though SSRIs have not worked for me in the past, might Lexapro work?
>
> Also, any news on whether Duloxetine has the same awful side-effects as effexor?
>
> Thanks for any tips.
>DissTired,
Many people who have atypical depression have an underlying mood disorder. This is what happen in my case. I was on a combo of a low dose ssri with a tricyclic. Lamictal was added about a year ago. Having great results. Up to 200mg and have been able to lower the AD's. Atypical depression responds more to AD's that target numerous neurotransmittors. The reason your AD's poop out may be that a mood stablizer is needed. This is very common with bipolar's to trial many AD's without much success. Hope this helps. Go to Depression Central web site and check out pages on atypical depression and bipolar.
Posted by polarbear206 on January 28, 2003, at 16:55:40
In reply to Re: atypical depression and antidepressants, posted by polarbear206 on January 28, 2003, at 16:44:42
> > Hi,
> >
> > I have atypical depression and used to get panic attacks. Desipramine helped for panic but not depression when I was younger. Then in my late 20s and early 30s parnate worked for me. I could only tolerate 20 mgs of parnate though, before my mind raced too much. Then in my early 30s, parnate just stopped working.
> >
> > Since then I've tried just about everything. SSRIs and remeron did nothing or worse. Effexor worked for depression but made me feel lobotomized and tired (10 hours of sleep was a minimum requirement), and also seemed to make my mind perpetually cloudy, which is bad news for an academic.
> >
> > My question is this. What other meds or med combos might work? Though SSRIs have not worked for me in the past, might Lexapro work?
> >
> > Also, any news on whether Duloxetine has the same awful side-effects as effexor?
> >
> > Thanks for any tips.
> >
>
>
>
> DissTired,
>
> Many people who have atypical depression have an underlying mood disorder. This is what happen in my case. I was on a combo of a low dose ssri with a tricyclic. Lamictal was added about a year ago. Having great results. Up to 200mg and have been able to lower the AD's. Atypical depression responds more to AD's that target numerous neurotransmittors. The reason your AD's poop out may be that a mood stablizer is needed. This is very common with bipolar's to trial many AD's without much success. Hope this helps. Go to Depression Central web site and check out pages on atypical depression and bipolar.
>
> http://www.psycom.net.depression/central.htmlTry this one.
Posted by Shawn. T. on January 28, 2003, at 19:00:53
In reply to Re: atypical depression and antidepressants, posted by polarbear206 on January 28, 2003, at 16:44:42
Jack's advice is excellent. MAOI's are the treatments of choice for atypical depression with comorbid panic disorder. If SSRI's have not worked in the past, trying another would be unadvisable. A good way to know if you have a bipolar spectrum disorder is to determine if you do or do not experience mood reactivity. One definition of mood reactivity is the ability to reach 50% of a non-depressed mood (during an episode of depression). Mood reactivity has been associated with atypical depression in bipolar II or cyclothymia, but it has not been associated with unipolar atypical depression. The depression central page on atypical depression is http://www.psycom.net/depression.central.atypical.html ... if you want a more thorough list of research, see http://www.neurotransmitter.net/atypicaldepression.html
Shawn
Posted by Maximus on January 28, 2003, at 19:19:08
In reply to Re: atypical depression and antidepressants, posted by polarbear206 on January 28, 2003, at 16:44:42
> Many people who have atypical depression have an underlying mood disorder. This is what happen in my case. I was on a combo of a low dose ssri with a tricyclic. Lamictal was added about a year ago. Having great results. Up to 200mg and have been able to lower the AD's. Atypical depression responds more to AD's that target numerous neurotransmittors. The reason your AD's poop out may be that a mood stablizer is needed. This is very common with bipolar's to trial many AD's without much success.
Dear Polarbear206,
I couldn't agree more with you on that subject. I'm glad you have good knowledge (and right informations) as i have (no bragging) because it is very helpful.
Lamictal has been/is THE answer for my atypical depression and my underlying mood disorder.
I think that Lamictal will be used more and more (for the depression and bipolar depression) in a very near future as it tends to reset the HPA axis without touching directly the monoamines, and all this with almost no side effects.
Live long and prosper, with the Lamictal (*smile*)
Max.
Posted by DissTired on January 28, 2003, at 22:47:49
In reply to Re: atypical depression and antidepressants, posted by Shawn. T. on January 28, 2003, at 19:00:53
> Jack's advice is excellent. MAOI's are the treatments of choice for atypical depression with comorbid panic disorder. If SSRI's have not worked in the past, trying another would be unadvisable. A good way to know if you have a bipolar spectrum disorder is to determine if you do or do not experience mood reactivity. One definition of mood reactivity is the ability to reach 50% of a non-depressed mood (during an episode of depression). Mood reactivity has been associated with atypical depression in bipolar II or cyclothymia, but it has not been associated with unipolar atypical depression. The depression central page on atypical depression is http://www.psycom.net/depression.central.atypical.html ... if you want a more thorough list of research, see http://www.neurotransmitter.net/atypicaldepression.html
>
> ShawnThanks for the help. I checked out the pages you suggested. I'm not sure I understand this mood reactivity thing. Are you supposed to feel more or less the same amount of depressed every day? When I'm really badly depressed, I almost never feel good. I ache in my arms, and I am mainly depressed about feeling so bad. However, I can often get a lot of exercise and feel 50% better for a brief period. I have never completely lost the ability to enjoy good news, though it doesn't really affect the underlying depression. Also, I might have days where I am only 50% as depressed as other days. But I'm still depressed. However, I have never had any kind of euphoria or grandiose thinking I associate with cyclothymia. Not have I had any extra energy days, where I needed less sleep. I always seem to need too much sleep.
Right now I'm feeling only a bit of depression, but it's enough to scare me. I'm trying to take moclobemide but am unsure as of yet whether it will keep me in semi-remission. I have not had full remission since the parnate stopped working.
Any other tips on how to figure out if I have mood reactivity would be helpful.
Oh yeah, reading about atypical depression has been scary. I don't really want another disorder and it seems to be associated with both bipolar and with personality disorders.
Posted by Shawn. T. on January 28, 2003, at 23:16:16
In reply to Re: atypical depression and antidepressants, posted by DissTired on January 28, 2003, at 22:47:49
Mood reactivity involves a noticeable improvement in mood in response to positive events. Improved mood due to exercise would not fall into this category. I don't believe that having a day when you feel better than normal for no particular environmental reason would qualify either. If someone gave you a compliment and your symptoms disappeared by at least 50%, then you would be exhibiting a clear case of mood reactivity. Your current diagnosis of atypical unipolar depression is probably correct, but I can't really say for sure. Remember that the fact that atypical depression is common in bipolar disorder does not implicate that everyone with atypical depression has bipolar disorder. The really sad fact is that the amount of research into atypical depression is so small compared to typical depression. I have no idea why so little is done on the topic; it's really a shame. We do seem to be making some ground, however.
Shawn
Posted by ricardo on January 29, 2003, at 6:09:07
In reply to Re: atypical depression and antidepressants, posted by Shawn. T. on January 28, 2003, at 23:16:16
Sorry my ignorance... Could anyone tell me what Atypical Depression is?
Thanks a lot,
Ricardo
Posted by DissTired on January 29, 2003, at 11:32:47
In reply to Re: atypical depression... What is it?, posted by ricardo on January 29, 2003, at 6:09:07
> Sorry my ignorance... Could anyone tell me what Atypical Depression is?
>
> Thanks a lot,
> RicardoIt is depression in which instead of losing sleep, you sleep too much, and instead of losing weight, you might eat too much. It also can involve feeling heavy or weighted down in your whole body, or in just your arms and/or legs. I think a lot of atypically depressed people are overly sensitive to other people's real and imagined rejections of them.
You can look at this web site for info:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11711170&dopt=AbstractFor some reason it's called atypical depression, but the web pages I've been looking at say it is very common, and maybe more common than "regular" depression.
Posted by polarbear206 on January 30, 2003, at 8:44:19
In reply to Re: atypical depression and Lamictal » polarbear206, posted by Maximus on January 28, 2003, at 19:19:08
> > Many people who have atypical depression have an underlying mood disorder. This is what happen in my case. I was on a combo of a low dose ssri with a tricyclic. Lamictal was added about a year ago. Having great results. Up to 200mg and have been able to lower the AD's. Atypical depression responds more to AD's that target numerous neurotransmittors. The reason your AD's poop out may be that a mood stablizer is needed. This is very common with bipolar's to trial many AD's without much success.
>
> Dear Polarbear206,
>
> I couldn't agree more with you on that subject. I'm glad you have good knowledge (and right informations) as i have (no bragging) because it is very helpful.
>
> Lamictal has been/is THE answer for my atypical depression and my underlying mood disorder.
>
> I think that Lamictal will be used more and more (for the depression and bipolar depression) in a very near future as it tends to reset the HPA axis without touching directly the monoamines, and all this with almost no side effects.
>
> Live long and prosper, with the Lamictal (*smile*)
>
> Max.Max,
Just want you to know that I ALWAYS read your posts. Thanks for your expert knowledge. You have been very helpful to everyone!!
How much lamictal are you on now? I hope I sail through the change of season coming up. March has always been a difficult month for me. This is when the anxiety sets in with mixed states. I have NO side effects with lamictal. See my pdoc early feb. I'm ready to go up to 300mg.
Posted by Maximus on January 30, 2003, at 9:42:26
In reply to Re: atypical depression and Lamictal MAX , posted by polarbear206 on January 30, 2003, at 8:44:19
> Just want you to know that I ALWAYS read your posts. Thanks for your expert knowledge. You have been very helpful to everyone!!
Thank you Polarbear206 :-)
> How much lamictal are you on now? I hope I sail through the change of season coming up. March has always been a difficult month for me. This is when the anxiety sets in with mixed states. I have NO side effects with lamictal. See my pdoc early feb. I'm ready to go up to 300mg.I'm taking 300 mg of Lamictal. This is my personal *sweet spot*. Lamictal has completely taken away my seasonal disorder. You should not fear. Anxiety is an insiduous trigger. Nevertheless, if you experiment anxiety spells (residual symptoms) you might consider to add temporary a mild benzo such as Xanax.
Good luck!
Max.
Posted by polarbear206 on January 30, 2003, at 17:28:08
In reply to Re: atypical depression and Lamictal » polarbear206, posted by Maximus on January 30, 2003, at 9:42:26
> > Just want you to know that I ALWAYS read your posts. Thanks for your expert knowledge. You have been very helpful to everyone!!
>
> Thank you Polarbear206 :-)
>
>
> > How much lamictal are you on now? I hope I sail through the change of season coming up. March has always been a difficult month for me. This is when the anxiety sets in with mixed states. I have NO side effects with lamictal. See my pdoc early feb. I'm ready to go up to 300mg.
>
> I'm taking 300 mg of Lamictal. This is my personal *sweet spot*. Lamictal has completely taken away my seasonal disorder. You should not fear. Anxiety is an insiduous trigger. Nevertheless, if you experiment anxiety spells (residual symptoms) you might consider to add temporary a mild benzo such as Xanax.
>
> Good luck!
>
> Max.
Max,I'll keep you posted with my future lamictal increases and hope the anxiety stays at bay this March. I took klonopin years ago before I got a true diagnosis. It worked great for anxiety.
Have you heard anything about the use of Zantac for weight loss from longterm AD induced weight gain? I saw a news segment on TV about this. The study done resulted in an average of a 25 lb weight loss over a period of a year for a high percentage who participated in the study.
Thanks, Laura.
Posted by Maximus on January 31, 2003, at 9:59:17
In reply to Re: atypical depression and Lamictal MAX, posted by polarbear206 on January 30, 2003, at 17:28:08
> I'll keep you posted with my future lamictal increases and hope the anxiety stays at bay this March. I took klonopin years ago before I got a true diagnosis. It worked great for anxiety.
Hi Laura,
True, clonazepam is the most powerful benzo. It might be a better choice if you are able to get off clonazepam rapidly.
> Have you heard anything about the use of Zantac for weight loss from longterm AD induced weight gain? I saw a news segment on TV about this. The study done resulted in an average of a 25 lb weight loss over a period of a year for a high percentage who participated in the study.
>
> Thanks, Laura.I didn't see the news on TV. However, i've heard about Zantac's properties. That sounds very promising. Zantac is a kind of HA-receptor antagonist, which reduces the production of stomach acid AND improves the metabolism's speed.
That's probably all i know about Zantac. But i would be **a little bit** worried about its interaction with the Lamictal on the liver and the sexual dysfunction.
Good luck!
Max.
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