![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by gardenergirl on April 17, 2005, at 2:04:11
Ugh, this has been building since early March, I think. But now I am in a major depressive episode. I've got all the criteria: insomnia, decreased appetite, loss of interest in stuff, isolation, low energy, low mood, irritability, difficulty concentrating, tearfulness, etc.
Current meds: Nardil 60mg
Armour thyroid 60 mg
Topamax 25 mg (down from 50 mg as of 8 days ago. I started this around March 10 to try to counter nardil weight gain, but the SE's are annoying me.)
I also did light therapy fairly diligently, with good response fall to spring. I stopped with the solstice and the daylight savings time.I have tried a number of SSRI's in the past, and none have had much of an effect. Also tried Celexa with Wellbutrin prior to going on Nardil, also no real effect. Nardil is first to ever put depression totally in remission and actually allow periods of feeling pretty good.
So any suggestions? I do have a GP appt. on Monday as well, and I will have him check thyroid, as it still doesn't "feel" quite right on the Armour. I used to take 50 mcg of Synthroid which worked well, but then TSH went up again, and I switched to Armour.
Any ideas and recommendations are welcome. One note, I have taken up to 67.5 mg Nardil before with good results. 75 mg gives me intolerable agitation and restlessness.
Thanks in advance.
gg
Posted by ixus on April 17, 2005, at 3:59:39
In reply to Help! Depression back--I see pdoc on Monday, posted by gardenergirl on April 17, 2005, at 2:04:11
> Ugh, this has been building since early March, I think. But now I am in a major depressive episode. I've got all the criteria: insomnia, decreased appetite, loss of interest in stuff, isolation, low energy, low mood, irritability, difficulty concentrating, tearfulness, etc.
>
> Current meds: Nardil 60mg
> Armour thyroid 60 mg
> Topamax 25 mg (down from 50 mg as of 8 days ago. I started this around March 10 to try to counter nardil weight gain, but the SE's are annoying me.)
> I also did light therapy fairly diligently, with good response fall to spring. I stopped with the solstice and the daylight savings time.
>
> I have tried a number of SSRI's in the past, and none have had much of an effect. Also tried Celexa with Wellbutrin prior to going on Nardil, also no real effect. Nardil is first to ever put depression totally in remission and actually allow periods of feeling pretty good.
>
> So any suggestions? I do have a GP appt. on Monday as well, and I will have him check thyroid, as it still doesn't "feel" quite right on the Armour. I used to take 50 mcg of Synthroid which worked well, but then TSH went up again, and I switched to Armour.
>
> Any ideas and recommendations are welcome. One note, I have taken up to 67.5 mg Nardil before with good results. 75 mg gives me intolerable agitation and restlessness.
>
> Thanks in advance.
>
> ggHi gg,
if anxiety is not a problem, I would try Parnate. It brings fast response usually. You shouldn't have problems with weight gain also. How did you feel before adding Topamax to Nardil?
/ixus
Posted by Sarah T. on April 17, 2005, at 12:10:06
In reply to Help! Depression back--I see pdoc on Monday, posted by gardenergirl on April 17, 2005, at 2:04:11
You said that you stopped using the light box. Why don't you resume using it? Just don't use it for as long as you used it during the winter. I use mine all year. In the summer, I'll use it for about 5 minutes a day, just for putting on makeup, tweezing eyebrows, etc., and it seems to help my mood. I don't know where you live, but in my neck of the woods, even with Daylight Savings Time, we still have plenty of overcast days.
Posted by gardenergirl on April 17, 2005, at 14:28:20
In reply to Re: Help! Depression back--I see pdoc on Monday, posted by ixus on April 17, 2005, at 3:59:39
Hi ixus,
My pdoc and I have talked about switching to Parnate before. We were a bit concerned about the transition and didn't want to rock the boat. But I suppose if I am already depressed, how much worse can it get? (I'm afraid to find out, though).And regarding anxiety, well, I don't experience it overtly. When Nardil kicked in I realized I must have some underlying anxiety, because I suddenly felt much more confident. So I don't know if that will make a difference if I switch. Does Parnate make anxiety worse at times?
And I felt much better before the Topamax, which is why I am discontinuing it.
Usually when I see my pdoc I have an idea of what I want or what the plan is. Now----no ideas. I am totally in her hands, which is kind of scary for me. But I guess that is how depressed I feel.
Thanks for you input.
gg
Posted by gardenergirl on April 17, 2005, at 14:29:59
In reply to Re: Help! Depression back--I see pdoc on Monday » gardenergirl, posted by Sarah T. on April 17, 2005, at 12:10:06
Yeah, going back to the light box seems a good idea. I think I just got tired of waking up early and using it even on days I did not need to get up that early.
But then trouble getting up in the a.m., sleeping in, and sleeping excessively is usually one of the first signs of depression for me. sigh
I'll give it a try.
gg
Posted by The_Resistance on April 17, 2005, at 14:57:14
In reply to Help! Depression back--I see pdoc on Monday, posted by gardenergirl on April 17, 2005, at 2:04:11
If Nardil has worked for you, then I'd think carefuly before discontinuing it.
Apparently Nardil can be aurgmented with a Noradrenaline specific TCA, such as desipramine or Nortryptaline, Lofepramine would also presumably be safe.
Adding a very low dose of L-tryptophan might help, but be careful!
Posted by TamaraJ on April 17, 2005, at 15:10:11
In reply to Help! Depression back--I see pdoc on Monday, posted by gardenergirl on April 17, 2005, at 2:04:11
GG,
I'm sorry you are going through such a rough patch. You don't deserve that. I'm not the most knowledgeable about meds, but I would think that perhaps the Topamax could be the culprit. I don't know much about Topamax, but I have read that it can depress the central nervous system, and one of the common side effects is fatigue while one of the less common side effects is apathy. I think you are probably wise to have started reducing your dose, with a view to eliminating it completely. And, I don't think it would hurt to re-start your light therapy, even if it is for a shorter period each day (as Sarah suggested).
I hope everything goes well on Monday. And I hope you start feeling better soon. My thoughts are with you. Take good care of you.
All the best,
Tamara
Posted by ed_uk on April 17, 2005, at 15:40:48
In reply to Help! Depression back--I see pdoc on Monday, posted by gardenergirl on April 17, 2005, at 2:04:11
Hi gg,
>One note, I have taken up to 67.5 mg Nardil before with good results.
Do you think you might return to 67.5mg??
Ed.
Posted by Maxime on April 17, 2005, at 16:45:13
In reply to Re: Help! Depression back--I see pdoc on Monday » ixus, posted by gardenergirl on April 17, 2005, at 14:28:20
Hi GG. I am sorry the beast is back. You know, many people feel decreased anxiety on Parnate. It's KNOWN to be activating, but it isn't always the case. I think you should give it shot.
BTW, how did ever get a doctor to give you Armour? I would really like to try that for my hypothyroidism. Do you have to have more frequest blood levels done.
Topomax was a disaster for me - acne, loss of brain cells, UTI and eventually psychosis. What a trip!
((( GG ))) Hang in there. Let us know what you decide or what change is made. I really think you should try Parnate because since you feel like crap now, well ....
Thinking of you. I wish I could be more help to you since you have helped me so much.
Maxime
> Hi ixus,
> My pdoc and I have talked about switching to Parnate before. We were a bit concerned about the transition and didn't want to rock the boat. But I suppose if I am already depressed, how much worse can it get? (I'm afraid to find out, though).
>
> And regarding anxiety, well, I don't experience it overtly. When Nardil kicked in I realized I must have some underlying anxiety, because I suddenly felt much more confident. So I don't know if that will make a difference if I switch. Does Parnate make anxiety worse at times?
>
> And I felt much better before the Topamax, which is why I am discontinuing it.
>
> Usually when I see my pdoc I have an idea of what I want or what the plan is. Now----no ideas. I am totally in her hands, which is kind of scary for me. But I guess that is how depressed I feel.
>
> Thanks for you input.
>
> gg
Posted by Phillipa on April 17, 2005, at 18:05:46
In reply to Re: Help! Depression back--I see pdoc on Monday, posted by Maxime on April 17, 2005, at 16:45:13
Hi gg, I seem to be encountering some depression creeping back. I don't want to take any more meds as they never seem to work. I'm hoping mine is due to some surgery and having to stay in the house. Hope your pdoc can help you. Fondly, Phillipa
Posted by Pfinstegg on April 17, 2005, at 21:50:28
In reply to Help! Depression back--I see pdoc on Monday, posted by gardenergirl on April 17, 2005, at 2:04:11
Hi gg: One of the things that helped me the very most was getting my TSH level down to below 1.0 (actually, with treatment, mine ranges from about .38 to .60). I take half of the thyroid replacement as Synthroid in the morning, and the other half as Cytomel in the morning and again in the early evening. I really do notice a lift in my mood about a half hour after taking the Cytomel. It has a short half-life of about three hours, so I do notice an up and down effect during the day. I know the Armour preparation contains both forms (T3 and 4), but am not familiar with whether it really gets your TSH down to an optimally low level. It sounds like a great idea to get it all checked out again. I know I've mentioned this before here, but taking enough thyroid replacement to get the TSH levels below 1 does carry a real risk of osteoporosis. I know you are very young to think about that, but it might be good to get a baseline DEXA scan, and then take adequate amounts of Calcium, Magnesium and Vitamin D as preventives, with plans to have the scans perhaps every five years or so. I was not told about this, and went from having a normal scan to having "fairly severe" osteoporosis within just five years of this intensive thyroid replacement. If I had known about the risk, I probably could have avoided getting it. I am doing OK, with Fosamax, and my scans are actually improving a bit, but STILL!
Something like careful attention to thyroid supplementation can make such a big difference- it has for me. From what I have read over the last couple of years, Nardil has been a wonderful drug for you. If it were me, I'd adjust all the other things before switching from the Nardil, although you might need more right now. Those MAOI's are so unusual in not losing their effectiveness, the way most other ADs do.
An additional thought: some people have depression which is very sensitive to any drop in estrogen levels. I recently noticed that NIMH is conducting several studies to learn more about that. If you find that your levels are lower than they should be for your age, there are quite safe ways to boost it up a bit- for example, using something like Ogen, a plant-based estrogen,
Posted by gardenergirl on April 17, 2005, at 22:20:37
In reply to Re: Help! Depression back--I see pdoc on Monday » gardenergirl, posted by Pfinstegg on April 17, 2005, at 21:50:28
You make some very good points. And considering that I skipped a period last month, which I attribute to thyroid or perhaps Topamax or both. But hmmm, estrogen could be a culprit, too. And yes, as ed also said (thanks ed!), I think going back to 67.5 is a good idea, but I'll let my pdoc suggest it instead of deciding on my own.
I take calcium regularly. I'll ask my doc about a dex scan. My mom has osteoporosis, so that's a good idea. Hey, maybe me and hubby can be Fosamax buddies. :)
Thanks for the encouragement. Looking forward to feeling better, whatever the plan is.
gg
Posted by gardenergirl on April 17, 2005, at 22:21:30
In reply to Re: Help! Depression back--I see pdoc on Monday, posted by ed_uk on April 17, 2005, at 15:40:48
Not a bad idea. I almost did that on my own, but this time I'm leaving it in my pdoc's hands.
Thanks,
gg
Posted by gardenergirl on April 17, 2005, at 22:29:42
In reply to Re: Help! Depression back--I see pdoc on Monday » gardenergirl, posted by TamaraJ on April 17, 2005, at 15:10:11
Thanks TamaraJ,
Honestly, I do feel a tad better since I started reducing the Topamax. And ironically, I have no appetite now. Weird.gg
Posted by Sarah T. on April 17, 2005, at 22:29:44
In reply to Re: Help! Depression back--I see pdoc on Monday » gardenergirl, posted by Pfinstegg on April 17, 2005, at 21:50:28
Hi Pfinstegg,
How much Calcium and Magnesium do you take each day, and what forms do you use (e.g., Calcium citrate or carbonate, Magnesium citrate or oxide or glycinate)?
Thanks.
Posted by gardenergirl on April 17, 2005, at 22:31:23
In reply to Re: Help! Depression back--I see pdoc on Monday, posted by Maxime on April 17, 2005, at 16:45:13
Hi Maxime,
Thanks for the support and the input about Parnate. About the Armour, well, I just asked. He was planning to just up my Synthroid. My GP tends to be a bit of a pushover. He is the one who originally started prescribing Nardil.gg
Posted by gardenergirl on April 17, 2005, at 22:33:28
In reply to Re: Help! Depression back--I see pdoc on Monday, posted by Phillipa on April 17, 2005, at 18:05:46
Hope you are feeling soon and on the road to recovery.
take care,
gg
Posted by Phillipa on April 17, 2005, at 22:37:01
In reply to Re: Help! Depression back--I see pdoc on Monday » Phillipa, posted by gardenergirl on April 17, 2005, at 22:33:28
Thanks gg! Fondly, Phillipa
Posted by Sarah T. on April 17, 2005, at 23:03:59
In reply to Re: Help! Depression back--I see pdoc on Monday » Sarah T., posted by gardenergirl on April 17, 2005, at 14:29:59
> Yeah, going back to the light box seems a good idea. I think I just got tired of waking up early and using it even on days I did not need to get up that early. > But then trouble getting up in the a.m., sleeping in, and sleeping excessively is usually one of the first signs of depression for me. sigh> I'll give it a try.> gg
Hi gg. I think it's worth giving the light box another try at a "lower dose." Keep in mind that it's still very early in the spring, and we really haven't reached the solstice yet. We just passed the equinox, with equal lengths of day and night. We still have a ways to go before the summer solstice, the longest day of the year, which is around June 22nd, I think. You've had such a good run on Nardil, I'd hate to see you give that up if you don't have to.
Posted by Pfinstegg on April 18, 2005, at 6:57:51
In reply to Pfinstegg, re: Calcium and Magnesium, posted by Sarah T. on April 17, 2005, at 22:29:44
I take 1500 mg. of Calcium Citrate, 400 mg. of Magnesium sulfate and 800 iu of Vitamin D. I also take 4 gms. of fish oil (Omega Brite), a general vitamin/mineral supplement which has a little of eveything, and quite high amounts oif B-Complex.I hate starting the day with so many pills ahnd capsules, but I know they are all helpful.
Posted by gardenergirl on April 18, 2005, at 9:26:38
In reply to Re: Pfinstegg, re: Calcium and Magnesium » Sarah T., posted by Pfinstegg on April 18, 2005, at 6:57:51
I hate taking so many pills too. And I often eat breakfast at work, so sometimes my boss will see me whip out my little pill box. I wonder what he thinks? :)
gg
Posted by gardenergirl on April 18, 2005, at 23:37:09
In reply to Help! Depression back--I see pdoc on Monday, posted by gardenergirl on April 17, 2005, at 2:04:11
So I saw her today. $100 later..."go back to what was working before".
Meaning get back to light therapy. Make sure thyroid is okay (checking that with GP). She gave me a scrip for Ambien when I mentioned the insomnia. And agreed when I asked if going to 67.5 mg of Nardil might be a good idea.
Sheesh. Why did I feel so helpless just a few days ago?
Idea of switching to Parnate is still on the table, but still on hold.
gg
Posted by Sarah T. on April 18, 2005, at 23:57:56
In reply to Re: Pfinstegg, re: Calcium and Magnesium » Sarah T., posted by Pfinstegg on April 18, 2005, at 6:57:51
Hi Pfinstegg,
Thanks for the information. I think I should be taking more Calcium. I take my magnesium at night because it makes me relaxed and, at times, groggy.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.