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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 jbarton83 on August 9, 2008, at 14:20:38
I'm really desperate. I feel like I have tried almost everything and I've been having a serious episode of depression for almost a year now. I can work here and there. I start Parnate on Monday and I really feel like I am running out of options. Here is the document I created to take with me to a new psychiatrist I am seeing on the 26th.
Current Symptoms
* Lack of motivation
* I'm not sad, but I feel hopeless and desperate
* Weight gain (128lbs -> 195lbs)
* * Excessive sleeping (12-14 hours per night) - This stopped when I went off SSRI's
* Uncontrollable appetite - Also dampened by going off SSRI's
* Takes a lot of effort to move around or do anything - This cycles throughout the day
* Nothing is more than marginally pleasurable
* Little to no libido
* Sometimes anxious; lots of social anxiety
* Low self esteem and confidence
* Positive for recent Epstein-Barr infection in March (Mononucleosis)
Past Symptoms
Spring 1997: First two panic attacks; took Buspar for a week; no panic attacks until Spring 20021999-2000: Social anxiety and self esteem problems enough to quit highschool
Fall 2001: 5mm Kidney stone, left kidney, lithotripsy
Spring 2002:
* Polyuria (full bladder every 10 minutes for up to an hour with no fluid intake)
* Flashing lights around peripheral vision
* Anxiety, panic attacks, overreact to everything
* High blood pressure (160/100)
* Severe hypochondriasis (maybe because I was working in a medical clinic)
* Headaches, pain in center of head
* Lost 12lbs (140lbs -> 128lbs)
* Frequent cloudy urine and urinalysis showed proteinuria several times
* Started Zoloft 25mg and quit job. After a week most of my anxiety and other symptoms went away.
2002-2007: Able to work a job with little responsibility. Took some easy classes. Lots of episodes of low motivation, hypersomnia, and depression.2006: 5mm wide, 9mm long kidney stone, left kidney, lithotripsy
September 2007-Current: Very severe depression. Quit school, very erratic work hours (10-30 hours a week). Just so you know, I have what I consider a dream job. I work for a professor who is also a good friend. I work in my field which I love (computer programming), and I live next door to work. There's not much else that could make it easier for me to work. I just can't do it.
Current Medications
* Xanax 0.5mg PRN
* Albuterol inhaler PRN
* Starting Parnate on MondayRecent Medication
* Zoloft 75mg QD
* Adderall XR 30mg, changed to Adderall 10mg BID - This provided me with instant relief, but it was very short-lived. I did well on and off for about two months before it completey pooped out and just gave me headaches.
* Abilify 10mg QD
* Lamictal 25mg QD
* Emsam 6mg - 9mg -- I definitely felt something from this, but it did not resolve my problems. It made me clear-headed and gave me some energy, but I still felt like crap.
All medications tried for depression / anxiety* Zoloft 25mg - 100mg
* Abilify 5mg - 10mg
* Xanax 0.25 - 0.5mg, for emergencies
* Paxil 25mg (2003)
* Cymbalta (2005)
* Lithium 300mg BID, then later 600mg BID
* Prozac 30mg QD
* Abilify 10mg QD
* Adderall XR 20mg QD, then 30mg QD, then Adderall SR 20mg BID (with Zoloft and Abilify), then back to Adderall XR
* Wellbutrin (with Zoloft)
* Strattera (with Zoloft, for motivation / concentration)
* Buspar (in 1997)
* Lamictal (2008)
* Emsam (Just stopped)
* Pristiq - Only took for one day
* Requip - As a dopaminergic mood brightener (did not work)
Other notes:* I am very against taking an SSRI, SNRI, or mood stabilizer. I haven't tried trycyclics. I've only been on one MAOI (selegiline).
* My dad has mental problems, including depression, agoraphobia, and panic disorder. He is on disability. I fear this may be my fate. I've already contacted a disability lawyer.
On Monday I start taking Parnate. The blood pressure thing has me a bit scared, but I'll have some Procardia on hand.So here is what I would like some help with. Besides any random comments that might be useful, I'd like some people to address my idea of augmenting my therapy with an opiate. I strongly believe my problem lies not with my monoaminergic system, but somewhere else. I did get significant relief from my depression last December when I was taking Lortab for pain from having four teeth extracted. I don't care which one I am put on, and I read there are some that are less likely to produce a euphoric effect, which is fine with me. I'm not looking to get high, I want to feel normal and go to work and school. I live in Columbia, Missouri. I'm willing to drive to St. Louis, Kansas City, Springfield, or basically anywhere within a 5-hour radius for treatment. I need to find a doctor who would be willing to put me on a trial of opiates to see if it provides me with some relief, if there are no other ideas. My doc thought the idea was ridiculous despite my mentioning of the article in the American Journal of Psychiatry about people who have achieved long-term remission from opiate augmentation.
Any other comments about my medication, symptoms, and pursuit of therapy will be appreciated, and thanks for your time.
James
Posted by bleauberry on August 9, 2008, at 19:03:45
In reply to So many meds, no relief, I need help, posted by jbarton83 on August 9, 2008, at 14:20:38
So sorry for your troubles. You are a very strong person and deserve a ton of respect. My hat's off to you. Best wishes on the Parnate too.
When people are very ill and not responding to multiple meds, I believe, as does my doctor, that we have to look beyond the brain and correct every single problem we can find or suspect. And even fix some blindly that may or may not be involveld. Basically, rule out nothing. With you there is obviously something going on in your body that is impacting the brain, but it may not be the brain itself at fault. Is that making sense?
Things to consider:
1) Do you have silver fillings? If yes, they HAVE to come out. Healthy people can handle the constant mercury exposure, ill people cannot. It is a very powerful nervous system toxin.
2) Adrenal and thyroid need to be optimized. Within normal range is not good enough, and is in fact not helpful. We can measure thyroid in blood but we cannot measure what it is doing in the cells. Only trial and error can tell us if thyroid treatment is helpful or not. It is not uncommon in psychiatric disorders. For adrenals, suggest a 24 hour 4-sample saliva cortisol test. If the curve is not normal, you will need either licorice root, adrenal cortex extract, or physiological replacement doses of hydrocortisone (1.25mg to 20mg) for about a year. When the adrenals are weak, the entire body malfunctions.3) Test for hidden food sensitivities. Gluten is the primary one. You would be amazed how badly a person can feel when they are reacting to a food they eat all the time and don't even suspect it. Believe me I know, I am gluten intolerant and suffered a long time before diagnosed. The second most common intolerance is the casseine protein found in dairy.
4) Healthy people can handle all kinds of lousy diets, but ill people need very special attention in diet. Low or no caffeine, low or no sugar, heavy on proteins, heavy on raw fruits and raw or slightly cooked veggies. Lots of water that has been purified, either purchased or through a good kitchen faucet filter (Aquasana brand). There are enough microbes, heavy metals (lead solder on your pipes), and flouride to further burden an already weakened person. No hydrogenated oils. Instead, olive oil, flax oil, and things like free-range organic eggs, avocados, walnuts, almonds. A low dose of purified fish oil is healthy too. Eating and drinking this way takes a couple months to get used to, especially when you have to replace wheat with rice, corn, potato, tapioca, and bean flours like I did (gluten) but after some time you actually prefer your new diet over the old one. May not be a miracle cure, though it has sometimes been, but benefits can be seen as early as 3 months and continue to grow for up to 2 years. Your body and brain need all the help you can give them. Feed them the right stuff that they can maximize their own genetically programmed defenses and healing.
5) Known infections, and even unknown ones, should be treated as long as it takes. You already know of one. That should be at the top of the list.
6) Consider meds from other countries. For example, the number one performing antidepressant in Japan is different than anything in the USA. I myself, who failed multiple drugs and ECT, find this particular med is showing me promise like I haven't seen in some time. The internet and mailorder opens up a whole new world in treatment.
7) Other supplements: Vitamin C and E, selenium and zinc. If you don't react badly to it, add magnesium. For liver support and overall cleansing, Milk Thistle herb. For any other meds, but not Parnate, I might have also mentioned SAMe. Not cool with MAOIs, and not cool if you have silver fillings.
8) You've had a number of strange physical problems in the past. Those should not be taken as random weird events. They are telling a story. Something is going on. Something that is not likely to spare the brain.
Basically, as my doc put it, we have to attack these things from multiple angles. We need to remove as many burdens on our body as we can that we know of, and remove other burdens blindly. To focus only on psych meds is only part of a larger treatment protocol, and a part that is likely to be fruitless unless other things are addressed simultaneously.
Hope this helps.
Posted by jbarton83 on August 9, 2008, at 19:36:09
In reply to Re: So many meds, no relief, I need help » jbarton83, posted by bleauberry on August 9, 2008, at 19:03:45
bleauberry, thank you for the extremely well-written, informative, and thoughtful response. I will be spending a lot of time going over your suggestions and probably trying some new things.
James
Posted by Phillipa on August 9, 2008, at 20:08:20
In reply to Re: So many meds, no relief, I need help, posted by jbarton83 on August 9, 2008, at 19:36:09
James let me welcome you to babble as see you are new. You might also wish to check the board as there are parnate threads there. Good luck to you and also hope you get a lot responses. Phillipa
Posted by jbarton83 on August 9, 2008, at 20:37:27
In reply to Re: So many meds, no relief, I need help » jbarton83, posted by Phillipa on August 9, 2008, at 20:08:20
> James let me welcome you to babble as see you are new. You might also wish to check the board as there are parnate threads there. Good luck to you and also hope you get a lot responses. Phillipa
Thanks for the welcome, Phillipa. I've done quite a bit of reading on Parnate, including here on the forums. I can hardly wait to see what it does, but I am quite cautious and will even have a blood pressure monitor and nifedipine on hand just in case.
James
Posted by jbarton83 on August 10, 2008, at 9:44:49
In reply to Re: So many meds, no relief, I need help » jbarton83, posted by bleauberry on August 9, 2008, at 19:03:45
bleauberry,
I can't seem to find the antidepressant from Japan that you referred to. Could you tell me its name?
James
Posted by jbarton83 on August 17, 2008, at 14:17:18
In reply to Re: So many meds, no relief, I need help, posted by jbarton83 on August 10, 2008, at 9:44:49
I'd like to give everyone an update.
I had some blood tests done and my iron and testosterone levels were very low. Now I am on an iron supplement and testosterone gel. This has definitely increased my physical energy and reduced my fatigue, but my brain has still been mush. I have mental energy, and I am even able to focus on my work. However, I feel like crap, find pleasure in nothing, hate everyone, and just generally feel dysphoric all the time.
Since I theorized I may have some endogenous endorphin related issues, I tried to convince my doctor to prescribe me Buprenorphine (Subutex). He wasn't very eager to do this, but I was able to get a prescription for Tramadol.
I took the Tramadol last night and this morning, and noticed a huge difference. In fact, I have felt pretty relieved so far, and I didn't have to take any Adderall this morning in order to function. It will take a few more days for me to decide if it is placebo effect or not.
I plan on adding Remeron tomorrow (SNRI + Remeron seems to be a promising combo). Does anyone know if this is only the case for Effexor + Remeron, or should any SNRI + Remeron or SSRI + NRI + Remeron work? Radical speculation welcome.
Thanks for the responses so far.
James
Posted by jbarton83 on August 25, 2008, at 10:29:44
In reply to Re: So many meds, no relief, I need help - Update!, posted by jbarton83 on August 17, 2008, at 14:17:18
Tramadol is still working very well and my symptoms are dramatically improved. In fact, I've written up a lengthy article about my experience and what I have learned about Tramadol.
You can read it here: http://whatisearchfor.blogspot.com/2008/08/tramadol-relieved-my-treatment.html
This is the end of the thread.
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