![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by SLS on January 23, 2009, at 6:03:04
A friend of mine is a 52 year old woman who has had double depression for most of her life. Double depression is the superimposition of major depressive episodes over chronic dysthymia. Right now, she is in a terrible depressive episode. She refuses to try any drugs at this point, and she has tried most of them, albeit mostly as monotherapy.
Wellbutrin in combination with Ritalin helps her. She must have some bipolar diathesis because she was hypomanic for awhile when she was younger. Lithium monotherapy kept her well for over 8 years until a new doctor discontinued it because "she had been on it long enough". She relapsed into depression within 4 weeks. Lithium did not work when she restarted it. She once responded to a combination of Nardil and Sinequan (doxepin), and briefly to Effexor and Lamictal monotherapeutically.
Thank you to everyone who replies.
- Scott
Posted by Garnet71 on January 23, 2009, at 7:44:21
In reply to Double depression and dysthymia: Treatment Ideas?, posted by SLS on January 23, 2009, at 6:03:04
Massive amounts of exercise!!!
Which is sooo hard to do when you are depressed; that's where a friend like you could help her :)
Posted by Phillipa on January 23, 2009, at 12:20:53
In reply to Re: Double depression and dysthymia: Treatment Ideas? » SLS, posted by Garnet71 on January 23, 2009, at 7:44:21
52 is average age for menopause. That's when my problems started. Hormones get them checked. Love Phillipa
Posted by desolationrower on January 23, 2009, at 13:12:13
In reply to Re: Double depression and dysthymia: Treatment Ideas?, posted by Phillipa on January 23, 2009, at 12:20:53
Well it sounds like stimulant type drugs work, and i'd think Li as well to prevent switching. Theres a lot of options in that general pattern...
-d/r
Posted by polarbear206 on January 23, 2009, at 13:28:08
In reply to Double depression and dysthymia: Treatment Ideas?, posted by SLS on January 23, 2009, at 6:03:04
> A friend of mine is a 52 year old woman who has had double depression for most of her life. Double depression is the superimposition of major depressive episodes over chronic dysthymia. Right now, she is in a terrible depressive episode. She refuses to try any drugs at this point, and she has tried most of them, albeit mostly as monotherapy.
>
> Wellbutrin in combination with Ritalin helps her. She must have some bipolar diathesis because she was hypomanic for awhile when she was younger. Lithium monotherapy kept her well for over 8 years until a new doctor discontinued it because "she had been on it long enough". She relapsed into depression within 4 weeks. Lithium did not work when she restarted it. She once responded to a combination of Nardil and Sinequan (doxepin), and briefly to Effexor and Lamictal monotherapeutically.
>
> Thank you to everyone who replies.
>
>
> - Scott
>Scott,
Do you know what doses she got up to with the effexor/lamictal combo? Very stupid move with the Doc stopping the Lithium.
Posted by desolationrower on January 23, 2009, at 14:55:28
In reply to Re: Double depression and dysthymia: Treatment Ideas?, posted by polarbear206 on January 23, 2009, at 13:28:08
i don't know that i'd call it very stupid. long-term Li can have negative effects.
-d/r
Posted by bleauberry on January 23, 2009, at 17:02:11
In reply to Double depression and dysthymia: Treatment Ideas?, posted by SLS on January 23, 2009, at 6:03:04
That's a sad story. I feel for her. What makes it really hard is that she refuses medications. I mean, it is kind of hard to help someone who is not willing to help themselves, yeah?
If it were my friend I would suggest St Johns Wort because something natural is usually viewed as more benign and more acceptable. I would let them know that SJW is a healthy herb all around, but that lifting mood is just one thing it can do. I would specify the Kira brand, which is available at Rite Aid pharmacies. It is the LI160 formula used in German clinical studies. SJW in my opinion is under-rated, because I have seen it produces results anywhere from mild to amazing in people with a history of meds. As I see it, it's better than nothing at all.
Another one that should work fast, and is kind of in the same vein as the meds that helped her, is SAMe. Definitely talk her into taking SAMe. To get away from the stigma of depression, tell her many people without depression take it for healthy joints and less pain. That might make it more palatable to someone refusing mood manipulating substances.
I wouldn't underestimate the potency of those two suggestions. They can and do work miracles every day.
Posted by softheprairie on January 24, 2009, at 4:14:21
In reply to Double depression and dysthymia: Treatment Ideas?, posted by SLS on January 23, 2009, at 6:03:04
This combination has been helping me of late:
-desipramine (I gradually got up to the maximum usual dose of 300 mg a day, but there are many lower doses possible)
-Cytomel
-perphenazine
-the beta blocker nebivolol to toletate the side effects of the desipramine making my heart beat too fast, have palpitations, and increase anxiety, which makes the desipramine sound pretty bad, but it's been very helpful mood-wise, when many others haven't
Posted by bgabes27 on January 25, 2009, at 8:02:23
In reply to Re: Double depression and dysthymia: Treatment Ideas?, posted by softheprairie on January 24, 2009, at 4:14:21
Hi Scott,
I agree, check an FSH to see if she's menopausal. I guess everyone's unique...I used to have the same dx but for me the following has helped alot: atypical antipsychotics (Abilify specifically), meditation (Andrew Weil claims it's the best long-term solution), and exercise like mentioned before.
Hope this helps,
Brian
Posted by SLS on February 6, 2009, at 8:46:51
In reply to Re: Double depression and dysthymia: Treatment Ide, posted by bgabes27 on January 25, 2009, at 8:02:23
Well, my friend finally relented and started taking lithium 600mg. She has experienced a significant improvment, and is no longer in the pit of deep despair.
Thanks to every one for their sincere and well thought-out advice.
- Scott
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.