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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by AMD on March 20, 2006, at 14:25:23
I'm very depressed today. Not withdrawal depressed, but sad and lonely and feeling hopeless in a way I haven't experienced in years.
I'm frustrated, too, that my doctors won't prescribe me an antidepressant. They just say "you need a mood stablizer," but never do anything to combat the depression.
I have been diagnosed bipolar, but I truly don't think I am. Hyperactive? Perhaps. Bipolar? No.
Yet as soon as I tell a new doctor that was previously my diagnosis, they hang on to it. It's as if they get biased in that direction and then refuse to diagnose me otherwise. (My current doctor talked to me all of fifteen minutes before prescribing Geodon [instead of Ability, even] because I was "speaking quickly." I always speak quickly!)
Right now, though, I am depressed and completely uninterested in anything. I get joy from absolutely nothing.
My regimen currently consists of once-daily dosages of Celexa and Lamictal. But frankly, I just don't feel they're working. My doctor added Geodon, but it just makes me feel worse and even more tired than I am already.
My only other pharmaceutical option seems to be a prescription for naltrexone I never filled. I've heard it can help boost the efficacy of SSRI's. I also heard, however, it can cause dysthymia. Any recent experiences? I looked through the medical archives on this site but discovered mostly equivocal results.
I also suspect this depression has been brought on by depletion of dopamine transmitters, likely cocaine-induced, but perhaps compounded by the Celexa, which I read can actually destroy dopamine or inhibit its release.
Any advice? Should I ask for another medicine? Anything that would help this lift?
amd
Posted by Declan on March 20, 2006, at 15:49:17
In reply to Depressed. New meds? Naltrexone augmentation?, posted by AMD on March 20, 2006, at 14:25:23
Hi AMD
Since you are partial to cocaine, maybe something more dopaminergic would be OK for you. No idea what in particular, but it sounds like a good place to start. And the naltrexone? Doesn't sound like much fun to me. You need maintenance treatment that is sufficiently tolerable that you don't need to break out from it too much. I can't really see the rationale for Celexa. And Geodon sounds like a very bad idea, for you in particular, I'd have thought. Having said that I'm ignorant about these Atypical APs. What about low dose amisulpride, if you were thinking of APs?
Declan
Posted by AMD on March 20, 2006, at 16:02:21
In reply to Re: Depressed. New meds? Naltrexone augmentation, posted by Declan on March 20, 2006, at 15:49:17
I'll mention that to my doctor. I just want this sadness to lift ...
amd
> Hi AMD
> Since you are partial to cocaine, maybe something more dopaminergic would be OK for you. No idea what in particular, but it sounds like a good place to start. And the naltrexone? Doesn't sound like much fun to me. You need maintenance treatment that is sufficiently tolerable that you don't need to break out from it too much. I can't really see the rationale for Celexa. And Geodon sounds like a very bad idea, for you in particular, I'd have thought. Having said that I'm ignorant about these Atypical APs. What about low dose amisulpride, if you were thinking of APs?
> Declan
Posted by Phillipa on March 20, 2006, at 21:42:00
In reply to Re: Depressed. New meds? Naltrexone augmentation, posted by AMD on March 20, 2006, at 16:02:21
I don't know what to say but it seems like everyone including me is sad. Love Phillipa
Posted by jerrympls on March 21, 2006, at 22:55:27
In reply to Depressed. New meds? Naltrexone augmentation?, posted by AMD on March 20, 2006, at 14:25:23
I tried the augmentation strategy of Naltrexone + SSRI. Had no real effect - but I'm not sure I was on the Naltrexone long enough. However, it didn't have any negative effects that I can remember.
Possibly look into a dopamine agonist (requip?) to help boost your dopamine - or perhaps a stimulant?
Posted by AMD on March 21, 2006, at 23:28:23
In reply to Re: Depressed. New meds? Naltrexone augmentation? » AMD, posted by jerrympls on March 21, 2006, at 22:55:27
> I tried the augmentation strategy of Naltrexone + SSRI. Had no real effect - but I'm not sure I was on the Naltrexone long enough. However, it didn't have any negative effects that I can remember.
>
> Possibly look into a dopamine agonist (requip?) to help boost your dopamine - or perhaps a stimulant?I am thinking the same. I don't know the current state of my brain, but I'm hoping I haven't done irreversible damage to it. Until my depression lifts and my concentration, memory, and cognitive clarity return, I'm sure I'll experience many a "panic attack" (figuratively).
I just want my brain healed. Back to normal. Perhaps one of these dopamine meds would allow me to reach a place I haven't been in ages: happy and enjoying life, not just "content" with it. (The latter has been my state of "happiness" the past five years.)
On a related note, does Celexa cause damage to or a decrease in dopamine? Or act as an antagonist? Might the high dose of Celexa actually be hurting in that regard?
Does cocaine actually kill brain cells, or does it alter the brains allocation of them in various areas?
amd
Posted by pseudoname on March 23, 2006, at 9:53:20
In reply to Re: Depressed. New meds? Naltrexone augmentation » jerrympls, posted by AMD on March 21, 2006, at 23:28:23
I tried naltrexone solo. I had a special theory on why it might work for me that way. (sigh, chuckle)
It didn't. But if you've got the script, I would certainly give it a shot. On naltrexone causing dysthymia: YES, that was my experience. I felt miserable in a way I never had before. But because I was expecting the dysthymia and I had great hope the drug would work, I hung on through that period (about 10 days, I think). Because I saw it as a necessary, temporary evil, it really wasn't that hard to bear, although it really was miserable. If that makes sense.
The few people who've been helped by naltrexone have such great stories that I really would give it a shot. But those success stories involve a prior SSRI response that's weak or pooped out.
I don't understand why your pdoc won't also give you an antidepressant. Getting a mood stabilizer doesn't rule out ALSO taking any AD. If I read the posts right, your doc was willing to prescribe naltrexone but not an SSRI?
Posted by Caedmon on March 25, 2006, at 13:55:47
In reply to Re: Depressed. New meds? Naltrexone augmentation » jerrympls, posted by AMD on March 21, 2006, at 23:28:23
Yes. Celexa [citalopram], as well as other SSRIs, can lower dopamine. I would probably agree to augmentation with a dopaminergic agent, but also consider *lowering* the citalopram. Good luck.
- C
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