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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by tensor on February 21, 2008, at 1:45:21
Have tried and given each antidepressant/antidepressant combo and augmenting substance a fair trial. Nothing really works in the long run. Currently I'm struggling to manage to drag myself to work. But there's never any surplus energy. Also, I seem to cycle between depressed states and episodes of 'more energy' but not hypomanic, i.e. 1-2 two weeks of energy. 1-2 two weeks without. I'm now taking Remeron 30mg + 30mcg of T3. I think T3 has done some improvement but it can't touch the 'down-episodes'.
I'm seeking a more stable mood and a higher mean of base-line. However, I lack a reference for what is 'normal', I'm I just whining? My pdoc has put me on behavioral activation, where I do exercises and fill out mood diaries.
Do you think medication-wise I have reach the end? I have not tried MAOI nor antipsychotics and with the mixed results I read on this board I'm not sure I want to. MAOI are not really used here. Any ideas, opinions greatly appreciated./Mattias
Posted by yxibow on February 21, 2008, at 3:59:32
In reply to List of conventional ADs exhausted, posted by tensor on February 21, 2008, at 1:45:21
> Have tried and given each antidepressant/antidepressant combo and augmenting substance a fair trial. Nothing really works in the long run. Currently I'm struggling to manage to drag myself to work. But there's never any surplus energy. Also, I seem to cycle between depressed states and episodes of 'more energy' but not hypomanic, i.e. 1-2 two weeks of energy. 1-2 two weeks without. I'm now taking Remeron 30mg + 30mcg of T3. I think T3 has done some improvement but it can't touch the 'down-episodes'.
> I'm seeking a more stable mood and a higher mean of base-line. However, I lack a reference for what is 'normal', I'm I just whining? My pdoc has put me on behavioral activation, where I do exercises and fill out mood diaries.
> Do you think medication-wise I have reach the end? I have not tried MAOI nor antipsychotics and with the mixed results I read on this board I'm not sure I want to. MAOI are not really used here. Any ideas, opinions greatly appreciated.
>
> /MattiasWhat is normal? There are multiple definitions of normal and what is reality. It really isn't fair to label oneself into a box.
I don't think at all that it is whining... and behavioural therapy, when the patient is a willing and active participant has been proven to be just as effective as some antidepressants.
I just don't like the word because it conjures to me that one is misbehaving, but that is not at all the case. Its changing the way one looks and views at things and trying to push through things with tested activities.
Excercises ("homework") are a valuable thing in therapy. And writing a diary to yourself can give you some retrospect when you look back at improvements. Not only that but it can give you some reminders of things you may want to ask your careprovider(s).
I assume you've tried Lamictal, just out of random curiosity, because it can be a fairly good antidepressant for some.
Yes, agents like Seroquel and Zyprexa have benefits that more than outweigh the risks when major depression or mood disorders are an issue and can be augmenters at low dose. I would definately steer towards them or other older antidepressants far before trying MAOIs but I know individuals here have other opinions, and that's fine.
30mg is not the limit for Remeron, one can go to 45+ on it, I wouldn't completely give up on it, personally. I know it is a weight gainer, or can be for some people, at any dose frankly (from just a personal trial) but it is a unique tetracyclic.
Anyhow I hope that provided some perspective, I wish you continued success with trying new things.-- Jay
Posted by Racer on February 21, 2008, at 9:35:41
In reply to List of conventional ADs exhausted, posted by tensor on February 21, 2008, at 1:45:21
I agree with Yxibow, who's usually got some good information to pass on.
Really, though, I just wanted to tell you that the mood charting helped me more than it seems possible. I kept a mood chart for several years, rating my mood, anxiety, irritability, agitation, etc, every time I ate. (The timing of my ratings was just convenience -- it was easy to get into the habit of noting those things when I was getting food out.) The mood charts helped me recognize patterns in my moods, offered a reminder that things weren't always as bad as they seemed at any given moment -- after all, I'd felt better at other times -- and just the fact of doing SOMETHING rather than sitting back hoping for the meds to perform magic was helpful.
Good luck.
Posted by Dopamine123 on February 21, 2008, at 19:17:32
In reply to List of conventional ADs exhausted, posted by tensor on February 21, 2008, at 1:45:21
Check out this other forum. There are a lot of good ideas about how to improve depression symptoms.
http://www.abolitionist-society.com/forum/Transcranial direct current stimulation:
http://www.abolitionist-society.com/forum/viewtopic.php?t=962Cranial_electrotherapy_stimulation
http://www.abolitionist-society.com/forum/viewtopic.php?t=973&highlight=cesAnti-inflammation drugs
http://www.abolitionist-society.com/forum/viewtopic.php?t=1199&highlight=http://www.abolitionist-society.com/forum/viewtopic.php?t=1191
transcranial magnetic stimulation
http://www.abolitionist-society.com/forum/viewforum.php?f=15&sid=950052b7db14ab93b8ddf09cfced32c3Though if you haven't tried MAOi's that might be a good place to start. Combinations of antipsychotics with antidepressants can also be helpful.
My neuroscience/neurotechnology blog:
http://brainstimulant.blogspot.com
Posted by bleauberry on February 21, 2008, at 21:00:35
In reply to List of conventional ADs exhausted, posted by tensor on February 21, 2008, at 1:45:21
All I know is that if you've given a bunch of different meds from different classes fair trials and none got you very far, then something else is wrong and we are looking at the wrong things.
In the book Amalgam Illness the PHd author gives many suggestions detailed to specificly target the various types of depression. He goes on to say that when nothing seems to work, look no further than the adrenals. Your symptoms fit.
A great place to get a fresh direction is a 24 hour 4 sample saliva cortisol test, which you can order on the net yourself from several labs or have a doctor do it. You can get a complete thyroid test that shows free T3, free T4, reverse T3, and the 3 antibodies. Forget TSH, it's useless. For links on places to learn about all this from other doctors around the world, try taking a look at links at stopthethyroidmadness.com.
When a bunch of psych meds fail, it is commen sense that something else is wrong. The problem is that you and me and most of us get so caught up in the medication arena we almost blindfold ourselves to the basics of the body that allow these meds to work in the first place. If the adrenals and thyroid are not doing their jobs correctly, there are no medications that are going to work for very long or very well. Maybe all along all that was needed was a modest bit of time release T3 or maybe a small physiological replacement dose of HC for the weak adrenals. Testing will make it a lot clearer.
Posted by bleauberry on February 21, 2008, at 21:03:36
In reply to List of conventional ADs exhausted, posted by tensor on February 21, 2008, at 1:45:21
I forgot to mention in the last post a couple things.
The T3 you are taking might be a lot better if it was time released from compounding pharmacy. See if your doctor will do that.
Second, to the few doctors who truly understand this stuff, they make it very clear and stern that thyroid meds will not help much if the adrenals are weak. Thyroid meds will actually put more strain on the adrenals and weaken them further. Many of these doctors will not touch the thyroid until the adrenals have been stabilized first, which is easy and cheap to do.
Posted by tensor on February 22, 2008, at 0:52:37
In reply to Re: List of conventional ADs exhausted » tensor, posted by bleauberry on February 21, 2008, at 21:03:36
Thanks for the input.
Yes I have tried Lamictal and lithium as antidepressant boosters and mood-stabilizers. None helped. Ttruth to be told, I'm scared of the anti-psychotics. How does Risperdal compare to Seroquel and Zyprexa?
I really think this mood chart thing is good, I'm doing them with a spread sheet so I can make some charts later and see how my mood changes and why.
I have been thinking about the adrenals and I actually brought it up a few months ago, I said that my problems could stem from adrenal fatigue but we didn't think about doing any tests, he didn't seem familiar with it, I will bring it up next time I see in march.
As he often states, this is a small area, with a relatively few patient, and hence the number of complex cases like mine are limited(which is good) so he rarely get the chance to try some more 'exotic' treatments.Thanks for your encouraging words,
Mattias
Posted by Racer on February 22, 2008, at 1:47:13
In reply to Re: List of conventional ADs exhausted, posted by tensor on February 22, 2008, at 0:52:37
>
> I really think this mood chart thing is good, I'm doing them with a spread sheet so I can make some charts later and see how my mood changes and why.Do you have Microsoft Access? I put together a database for mine, with forms, reports, etc, and it allowed for charting. I'd be happy to send it on to you, if you're interested.
And even if you're not interested in the thing I put together -- which admittedly had a lot of stuff that was only relevant to me -- I do think it's a good idea. I learned that my mood improved in the late afternoon, and that I did much better if I was out of bed by about 8AM. That information alone was worth whatever effort was involved. I also included things on the chart like when I went to the pdoc, therapist, regular doctor; how much and what sort of exercise I did; notes about things that went on; and other random things. All of it was worth knowing, as far as I was concerned.
In fact, it occurs to me that I might do well to start that up again...
Best luck to you, and I do hope you feel some improvement soon. (And it's only partly because I like the name Mattias so much. I used to hear stories about wise King Matyas, which may be part of that...)
Posted by Jedi on February 22, 2008, at 2:49:02
In reply to List of conventional ADs exhausted, posted by tensor on February 21, 2008, at 1:45:21
Hi,
There is a school of thought that unless you have given an adequate trial to an irreversible MAOI, your depression can not really be called treatment resistant. I have tried over forty-five combinations of ADs and augmentors. The only thing that has worked for my atypical depression and social anxiety is Nardil with clonazepam. And it put the hammer down.What country are you from?
Good luck,
Jedi> Have tried and given each antidepressant/antidepressant combo and augmenting substance a fair trial. Nothing really works in the long run. Currently I'm struggling to manage to drag myself to work. But there's never any surplus energy. Also, I seem to cycle between depressed states and episodes of 'more energy' but not hypomanic, i.e. 1-2 two weeks of energy. 1-2 two weeks without. I'm now taking Remeron 30mg + 30mcg of T3. I think T3 has done some improvement but it can't touch the 'down-episodes'.
> I'm seeking a more stable mood and a higher mean of base-line. However, I lack a reference for what is 'normal', I'm I just whining? My pdoc has put me on behavioral activation, where I do exercises and fill out mood diaries.
> Do you think medication-wise I have reach the end? I have not tried MAOI nor antipsychotics and with the mixed results I read on this board I'm not sure I want to. MAOI are not really used here. Any ideas, opinions greatly appreciated.
>
> /Mattias
Posted by yxibow on February 22, 2008, at 3:28:22
In reply to Re: List of conventional ADs exhausted, posted by tensor on February 22, 2008, at 0:52:37
> Thanks for the input.
>
> Yes I have tried Lamictal and lithium as antidepressant boosters and mood-stabilizers. None helped. Ttruth to be told, I'm scared of the anti-psychotics. How does Risperdal compare to Seroquel and Zyprexa?Risperdal is the most strongest and the Ki binding strength at D2 is similar to Haldol at strong enough doses although they are different compounds.
Zyprexa and Seroquel are on the low potency end of atypicals in general
As I am although I take them for a different reason and it helps organize things for a rare disorder at the moment.
See:
Posted by cactus on February 22, 2008, at 5:19:47
In reply to List of conventional ADs exhausted, posted by tensor on February 21, 2008, at 1:45:21
Have you tried modafinil?
Posted by tensor on February 26, 2008, at 9:10:17
In reply to List of conventional ADs exhausted, posted by tensor on February 21, 2008, at 1:45:21
If Lithium and Lamictal didn't work, is there any idea trying another one like valproate? Given the cyclothymic nature of my depression. Although Lamictal didn't work, I was in a seven month long depressive episode when I tried it, could the outcome be different now when I'm a a little better?
/Mattias
Posted by yxibow on February 26, 2008, at 14:00:55
In reply to So what tot try next?, posted by tensor on February 26, 2008, at 9:10:17
> If Lithium and Lamictal didn't work, is there any idea trying another one like valproate? Given the cyclothymic nature of my depression. Although Lamictal didn't work, I was in a seven month long depressive episode when I tried it, could the outcome be different now when I'm a a little better?
>
> /MattiasLamictal is a long titration drug and I have heard of people on 600mg of it. It is a fairly good antidepressant. But Depakote is a time tested option for cyclic/BP depression as well so that is an idea.
This is the end of the thread.
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