Psycho-Babble Medication Thread 368434

Shown: posts 1 to 13 of 13. This is the beginning of the thread.

 

Refractory Depression

Posted by haaser on July 20, 2004, at 22:41:33

Any advice for someone with severe depression who has not esponded to standard treatment?

 

Re: Refractory Depression

Posted by Piquet on July 20, 2004, at 23:55:50

In reply to Refractory Depression, posted by haaser on July 20, 2004, at 22:41:33

> Any advice for someone with severe depression who has not esponded to standard treatment?

I too have treatment resistant major depression which is considered to be atypical. Over many years the only ADs I've really responded to (and I've tried many) have been in the MAOI class. If your standard treatment hasn't yet included a trial of a MAOI, perhaps you could discuss it with your psych. They're not considered a 'first line' drug because of dietary restrictions, but with care there's very little risk involved and for me they have been of significant benefit. Nardil (phenelzine) and Parnate (tranylcypromine) seem to be the most popular. Use the Google search function on Dr Bob's site to find lots of information on these ADs and their effects. Good luck.

Piquet.

 

Re: Refractory Depression

Posted by Bill LL on July 21, 2004, at 12:39:38

In reply to Refractory Depression, posted by haaser on July 20, 2004, at 22:41:33

It seems that a lot of non-responders are simply taking too low of a dose of their AD.

Maybe you should ask your doc about trying an AD that you tried in the past, but at a higher dose.

 

Re: Refractory Depression

Posted by Racer on July 21, 2004, at 14:06:39

In reply to Refractory Depression, posted by haaser on July 20, 2004, at 22:41:33

Depends on what you mean by "standard treatment" -- there are so many different drugs out there, and they all work a little differently. Some folks here really have done a lot of research on the various drugs available, and can probably point out options to try if they know what you've tried so far. Can you list the drugs you've tried so far, with a quick note about what they did and didn't do? That will give them the information they need to offer practical suggestions for you.

A lot of doctors these days, especially PCPs, will stick with the SSRIs because they're so much safer than the older drugs. That would be great if "safer" were synonymous with "more effective", but it isn't. If your treatment has been limited to the newer drugs, then there are a myriad of options available that might be extremely helpful for you, but we'd need to know what you've tried so far and what the results have been.

Best luck.

 

Re: Refractory Depression

Posted by SLS on July 23, 2004, at 7:04:55

In reply to Re: Refractory Depression, posted by Racer on July 21, 2004, at 14:06:39

> If your treatment has been limited to the newer drugs, then there are a myriad of options available that might be extremely helpful for you,

Might these include MAOIs?

:-)


- Scott

 

Re: Refractory Depression

Posted by Racer on July 23, 2004, at 9:49:46

In reply to Re: Refractory Depression, posted by SLS on July 23, 2004, at 7:04:55

> > If your treatment has been limited to the newer drugs, then there are a myriad of options available that might be extremely helpful for you,
>
> Might these include MAOIs?
>
> :-)
>
>
> - Scott


Maybe...

Scott, it's nice to have you tease me. Thank you. It brought a smile to my face, and a warm feeling to the region alleged to contain my heart.

The full truth is that I'm actually interested in the possibility of trying an MAOI -- but I just can't get the support necessary to take a step like that from Dr EyeCandy, so I'm looking for more benign alternatives until I can get out of this county-contracted system. And, before trying something that would require giving up my liverwurst sandwich, I would want to try to address the hypotension so that I could try desipramine again.

But yes -- amongst those myriad alternatives are MAOIs and TCAs.

And you're the best -- you know it must be true, if I say it...

 

Re: Refractory Depression

Posted by SLS on July 23, 2004, at 10:11:47

In reply to Re: Refractory Depression, posted by Racer on July 23, 2004, at 9:49:46

> > > If your treatment has been limited to the newer drugs, then there are a myriad of options available that might be extremely helpful for you,

> > Might these include MAOIs?
> >
> > :-)

> Maybe...
>
> Scott, it's nice to have you tease me. Thank you. It brought a smile to my face, and a warm feeling to the region alleged to contain my heart.
>
> The full truth is that I'm actually interested in the possibility of trying an MAOI -- but I just can't get the support necessary to take a step like that from Dr EyeCandy, so I'm looking for more benign alternatives until I can get out of this county-contracted system. And, before trying something that would require giving up my liverwurst sandwich, I would want to try to address the hypotension so that I could try desipramine again.

I'm sure you were presented with the idea of using Florinef (fludrocortisone) to raise your blood pressure. I never really researched the matter too far. What are your thoughts on it?

I'm very glad you are so clear on what you want for yourself right now. Your sense of direction is reassuring.

- Scott

 

Re: Refractory Depression

Posted by Racer on July 23, 2004, at 12:20:44

In reply to Re: Refractory Depression, posted by SLS on July 23, 2004, at 10:11:47

>
> I'm sure you were presented with the idea of using Florinef (fludrocortisone) to raise your blood pressure. I never really researched the matter too far. What are your thoughts on it?


Ironically, my thoughts on it is that, if the idea of using Florinef were presented to me at all, it would reassure me about trying either the desipramine or an MAOI... (Heheheh... See why I'm reluctant to try some of these with Dr EyeCandy?) So far, the only response from Dr EyeCandy -- or any other doctor, for that matter -- has been to say, "Well, if it's causing discomfort, discontinue it..." If any of them would address the problem -- sudden unintentional close up views of the carpet, in this case -- rather than simply telling me to stop the drugs, I would feel a lot more comfortable trying some of these other drugs.

So, long answer for you, just repeating the same thing: never been offered, and I'd try it if it was.
>
> I'm very glad you are so clear on what you want for yourself right now. Your sense of direction is reassuring.
>
> - Scott
>
Thank you. The last few days have been especially rough for me, and I am slipping quickly from where I was. It's distressing, to say the least. (And I'm having trouble reading again.) At least now I have a little more clarity about the problem as it relates to Dr EyeCandy, which is a good enough first step for me.

Guess I'll wait and see what comes next, at least I've got good company while I wait.

 

Re: Refractory Depression Racer

Posted by SLS on July 23, 2004, at 13:43:28

In reply to Re: Refractory Depression, posted by Racer on July 23, 2004, at 12:20:44

Hi Racer.

> > I'm sure you were presented with the idea of using Florinef (fludrocortisone) to raise your blood pressure. I never really researched the matter too far. What are your thoughts on it?

> Ironically, my thoughts on it is that, if the idea of using Florinef were presented to me at all, it would reassure me about trying either the desipramine or an MAOI...

Hmmm.

> (Heheheh... See why I'm reluctant to try some of these with Dr EyeCandy?)

Yes.

> So far, the only response from Dr EyeCandy -- or any other doctor, for that matter -- has been to say, "Well, if it's causing discomfort, discontinue it..." If any of them would address the problem -- sudden unintentional close up views of the carpet, in this case -- rather than simply telling me to stop the drugs, I would feel a lot more comfortable trying some of these other drugs.

Yes.

You need people with greater expertise in treating difficult cases such as yours aggressively. Aggressive treatment sometimes means using drugs with side effects that are significant enough to require remedial medical treatments themselves. Is there any chance you might want to educate Dr. E. on the use of Florinef? I have found that the hypotensive effects of TCAs and MAOIs decrease over time. Perhaps you would need Florinef for only the first 3-6 months.

Which TCA have you been on the longest and highest dosage of?


- Scott

 

Re: Refractory Depression

Posted by Racer on July 23, 2004, at 18:18:17

In reply to Re: Refractory Depression Racer, posted by SLS on July 23, 2004, at 13:43:28

Only one I've been able to stay on is Nortriptyline, and there's not much chance I'd be willing to try it again. Insomnia, constipation, ineffective, and packed on the pounds. The only reason it was at all tolerable was that the doctor added L-Tryptophan at a very high dose -- sorry, can't remember any of the dosages involved, this was almost 20 years ago and it never occurred to me that I'd need to remember this stuff down the line. I do remember that I was taking about 14 pills per day, though, about half of each. With the addition of the L-T., it worked well enough to allow the therapy to work for me, which was really all it had to do then.

Since then, I have experienced better results, but again with drugs that had too many drawbacks for me to consider trying again. (OK, the most effective was Effexor XR 225mg and Prozac 10mg -- but that was still only effective if my life was devoid of stress and even that level went away after about a year. Since the withdrawal process was so bad and lasted so long, I'm hardly eager to try it again.) I'd rather explore other options, like a TCA or even an MAOI, but -- again -- not unless I've got a doctor who will work with me to minimize the problems.

I, too, have a suspicion that the worst of the S/Es would fade after adjustment -- but that still requires me to get through the adjustment. Under these circumstances, with the [lack of] support I'm getting now, that would basically require me to stay in bed for as long as it took to make the adjustment, and that just doesn't seem all that reasonable to me. And, since the "support" issue ain't gonna change, that means waiting until I can get out of this particular set of circumstances.

Until then, at my next appointment, I'm going to suggest we try Strattera again -- both because I think now that all the other drugs I was on when we tried that were the cause of the worst side effects, and because it's really the most benign option I can think of considering the reality of my circumstances. When we tried it, I was better than I am now. Not great, but better than now. The problems that I associated with it now seem to have been related to those other drugs -- based on those drugs without the Strattera -- with one exception that would be really irritating, but not a deal-killer.

Whoops! Sorry, long post again... (Although I did edit it, in hopes it would be easier for you.)

Listen, about that histimine thing -- without giving you any other details here, for personal reasons -- I have seen treatment with cyproheptidine increase alertness, interest, and energy in depression secondary to medical problems. Those cases were related to HPA axis problems, but it's still an avenue well worth exploration, in my opinion.

Just tell me what you find out, 'K?

 

Re: Refractory Depression haaser

Posted by BarbaraCat on July 24, 2004, at 12:29:24

In reply to Refractory Depression, posted by haaser on July 20, 2004, at 22:41:33

> Any advice for someone with severe depression who has not esponded to standard treatment?

**What are your symptoms? What have you tried?

My breakthrough came when I added lithium. Didn't realize I was Bipolar-II because I had the stereotypical view of 'mania'. Didn't realize 'mania' could also be very agitated depression, insomnia, irritability, despair. Have you had your thyroid tested?

 

Re: Refractory Depression

Posted by platinumbride on July 24, 2004, at 12:56:43

In reply to Re: Refractory Depression, posted by Racer on July 23, 2004, at 18:18:17

(((((((((((((RACER)))))))))))))))


It pains me to see you read of you struggling so.

I just hope so much that there will come a workable solution for you. Aside from that there seems to be little I can say to make it better. Hell, I'm sure we'd all love to write that we are better and sit around drinking mint julieps laughing at the days when we were so depressed it hurt.

I mean they seem to do that on the TV commercials for ADs, so why can't they make it true for real life??? Are those marketing people just tapping into our innnermost desires???
No....they couldn't be...they care about people, not just selling drugs. HAH.


Hugs,

Diane

> Only one I've been able to stay on is Nortriptyline, and there's not much chance I'd be willing to try it again. Insomnia, constipation, ineffective, and packed on the pounds. The only reason it was at all tolerable was that the doctor added L-Tryptophan at a very high dose -- sorry, can't remember any of the dosages involved, this was almost 20 years ago and it never occurred to me that I'd need to remember this stuff down the line. I do remember that I was taking about 14 pills per day, though, about half of each. With the addition of the L-T., it worked well enough to allow the therapy to work for me, which was really all it had to do then.
>
> Since then, I have experienced better results, but again with drugs that had too many drawbacks for me to consider trying again. (OK, the most effective was Effexor XR 225mg and Prozac 10mg -- but that was still only effective if my life was devoid of stress and even that level went away after about a year. Since the withdrawal process was so bad and lasted so long, I'm hardly eager to try it again.) I'd rather explore other options, like a TCA or even an MAOI, but -- again -- not unless I've got a doctor who will work with me to minimize the problems.
>
> I, too, have a suspicion that the worst of the S/Es would fade after adjustment -- but that still requires me to get through the adjustment. Under these circumstances, with the [lack of] support I'm getting now, that would basically require me to stay in bed for as long as it took to make the adjustment, and that just doesn't seem all that reasonable to me. And, since the "support" issue ain't gonna change, that means waiting until I can get out of this particular set of circumstances.
>
> Until then, at my next appointment, I'm going to suggest we try Strattera again -- both because I think now that all the other drugs I was on when we tried that were the cause of the worst side effects, and because it's really the most benign option I can think of considering the reality of my circumstances. When we tried it, I was better than I am now. Not great, but better than now. The problems that I associated with it now seem to have been related to those other drugs -- based on those drugs without the Strattera -- with one exception that would be really irritating, but not a deal-killer.
>
> Whoops! Sorry, long post again... (Although I did edit it, in hopes it would be easier for you.)
>
> Listen, about that histimine thing -- without giving you any other details here, for personal reasons -- I have seen treatment with cyproheptidine increase alertness, interest, and energy in depression secondary to medical problems. Those cases were related to HPA axis problems, but it's still an avenue well worth exploration, in my opinion.
>
> Just tell me what you find out, 'K?

 

Parnate with Mirapex or Pergolide

Posted by EERRIICC on July 29, 2004, at 17:29:38

In reply to Re: Refractory Depression, posted by platinumbride on July 24, 2004, at 12:56:43

Can I augment Parnate with Mirapex or Pergolide?

Is there something better to augment it with?


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