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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by JohnLA on September 2, 2011, at 0:57:07
hi all-
this is my first post. i have been lurking for the past year and want to say first, thank-you to all the people who post on here. there is quite a bit of info and advice which i found helpful.
i am in my first ever serious depression. it's been 18 months now. i may have been in a mild depression for a few years before i got hit by several events in 2009/2010 that just overwhelmed me emotionally and i crumbled. i'm 49 and in a very severe mid-life crisis, so-to-speak. ;)
i have not worked since april, 2010. i am currently on 30mg of remeron and about a 1 to 1.5mg of klonopin per day.
i'm somewhat stuck in my recovery. i have basically been in bed for the last 18 months. i initially tried lexapro, cymbalta, celex and wellbutrin. i also did 12 ect's (unilateral). these all did not work. i had some improvement around 8 months ago when i was put on remeron. at least my sleep schedule went back to normal for the most part.
my first question; i am slowly trying to ween off the klonopin. i've been on it for a year now. i'm hoping that this will help with my apathy/anehdonia (sp?). any advice on this strategy would be appreciated. not so much on how to wean, but if anybody here has seen their emotions come back once off the klonopin. i've been told and read that klonopin can add to one's depression and emotional blunting. my pdoc seems to think it's more my depression than the klonopin causing the anehdonia.
next, i am 'better' in some ways. less agitated than i was a year ago. sleep is better. not much else has improved/changed though...
ruminating thoughts, suicidal ideation, laying in bed all day/night, and the above mentioned apathy/anehdonia for all the things i used to love and care about which may be the scariest part of all, save for the suicidal thoughts. so,
my next question is; i'm curious if people have seen their depression end with time and patience? (one of my favorite tolstoy quotes is, 'time and patience are the greatest warriors.') like i said, i do seem to be getting ever so slightly better as time goes by. but, at the same time i feel very stuck and nervous about these suicidal thoughts that i have. i never had them before and it still freaks me out that i actually have a plan, etc.
i miss my job, old social life, and healthy lifestyle (gym, good food, travel). i have become very reclusive and i isolate a lot and spend hours on the computer researching depression. this is the teacher in me and i think i may have some ocd in me. i live alone, but have cut-off most family and friends and rarely go out except with a few 'safe' friends.
i go to talk therapy once a week. not sure it helps, but 'they' say it is good to do. as you can see, i have no problem talking and i'm pretty sure i know how i got myself into this depression. not sure i'll have any major revelations come about. still, i will continue with the talk therapy.
final question; i see my pdoc next week and would like to go to her with some suggestions as to what to add possibly. she's really been pushing effexor as an add-on to the remeron. i'm reluctant to do so because i hear that effexor can really make you 'feel' less. also, the horror stories about missing a dose or coming off it have me not too excited about taking it. i'm pretty sensitive to medication, but i realize i need some sort of boost to get my butt moving and back to life. anybody here taking remeron with something else that proved beneficial?
sorry for the long post. like i said i'm a talker. hope you can find my 3 questions in all the rambling above.
thanks in advance for any help/suggestions/hope.
john
Posted by creepy on September 2, 2011, at 2:51:32
In reply to med help/suggestions/advice/does it get better?, posted by JohnLA on September 2, 2011, at 0:57:07
Maybe try adding effexor to remeron. Thats a popular combo for serious depression.
Some people do really well on TCAs. thats another option. After that your doc may try AAP's, mood stabilizers and possibly MAOIs. Your doc may try adding lithium to an antidepressant, thats also common.
Also, if the depression is situational you -need- a therapist, if you dont already have one.
Posted by JohnLA on September 2, 2011, at 4:18:26
In reply to Re: med help/suggestions/advice/does it get better?, posted by creepy on September 2, 2011, at 2:51:32
thnx creepy. (cool nickname!) i'm thinking it's time to try the effexor. just wish it didn't get such nasty press. and yes, my depression started off as situational (multiple stressors) and i am doing talk therapy.
thanks again for your advice.
john
Posted by Lepus on September 2, 2011, at 11:13:21
In reply to Re: med help/suggestions/advice/does it get better?, posted by JohnLA on September 2, 2011, at 4:18:26
Effexor works but yes, it isn't fun to miss a dose or to taper off it. However, most drugs have these issues. You aren't really going to be able to avoid them.
There is some hope also. Set reminders so you don't miss a dose. If you need to stop the drug, do it gradually. I did it by buying my own gel caps and reducing my dosage two or three caplets at a time (or whatever those little balls inside the gel caps are called.) I still had some symptoms but they were pretty mild.
It sounds like you have been struggling for a while. I hope you can find some relief.
Oh, and researching every med on the Internet is OCD behavior. I found this out about myself lately. So maybe work with your therapist on stopping the behavior. Most of what you read on the Internet is the worst case scenario anyway. The people who had no issues aren't spending their time writing reviews. Don't let what you read stop you. Your reaction is likely to be different. We don't react the same to drugs.
Good luck!
Posted by Phillipa on September 2, 2011, at 12:17:15
In reply to Re: med help/suggestions/advice/does it get better?, posted by Lepus on September 2, 2011, at 11:13:21
Lepus not to hijack thread but you mention therapist and people posting worst case scenarios. So if you find a pdoc on internet as a referral and read what a patient said about the doc and it's negative do you feel it's an angry patient or would you go by the review written? As the one recommended for me got a bad review from one patient only one given. And also you feel what kind of therapist is best for fears and aging issues? Sorry to get off topic. Original thread poster welcome and I've also heard effexor and remeron is called California Rocket fuel. Phillipa
Posted by Roslynn on September 2, 2011, at 13:32:15
In reply to med help/suggestions/advice/does it get better?, posted by JohnLA on September 2, 2011, at 0:57:07
Hi JohnLA,
I can relate to most of what you said. No one can really understand the experience of depression unless they have been through it themselves.
I hope you will find some good answers and support here as I have.
Best,
Roslynn
Posted by Lepus on September 2, 2011, at 14:35:19
In reply to Re: med help/suggestions/advice/does it get better? » Lepus, posted by Phillipa on September 2, 2011, at 12:17:15
Phillipa,
There was only one negative review? I think I would give them a chance. What did the review say? You've been here long enough to be able to tell if a pdoc isn't competent.
I think it is more important to find out if they have ever been disciplined.
I'm not sure what kind of therapist is best for aging fears. I think it all probably comes down to the same two issues: not handling uncertainty well and then catastrophizing the unknown. I think any decent therapist should be able to help you with those fears.
Sorry you're having such a hard time finding another pdoc, Phillipa.
Posted by Solstice on September 2, 2011, at 16:16:41
In reply to med help/suggestions/advice/does it get better?, posted by JohnLA on September 2, 2011, at 0:57:07
Hi JohnLA - and Welcome!!
When I was at the peak of my depression, I also experienced anhedonia. I had several years of very difficult stressors, during which I believe a low-level depression/anxiety took root. Then, several huge crisis crashed in simultaneously, and I was in bad enough shape that I knew to seek treatment. I was put on Zoloft and Wellbutrin. It is difficult for me to discern whether it was the depression or zoloft that caused the anhedonia. Initially, the anhedonia was a relief, because it was better than the pain and fear that had been overwhelming me. But after a while, the anhedonia itself became counter-productive because - like you describe - I was vegetablish. I didn't care about anything. I eventually weaned off the zoloft, and increased the wellbutrin. Main thing that I'll say that addresses your questions is that on the wellbutrin alone, the severe anhedonia subsided for the most part. I think the worst of it lasted about 6 months. Recovering 'feelings' has been a slow road. I've been on that road for about 4 years now.
Like you, I cut myself off from everyone.. and I didn't care.
There are several components to my relative progress.
1. I cannot miss my Wellbutrin. One day doesn't hurt me, but if I miss two days, I'm in trouble... I can feel myself slipping into a deep, dark cavern.. like something's got me by the feet and is pulling me down. Problem is, though, that the negative thinking that overtakes me seems so logical, that I can't pull myself out. Life just starts to suck so bad (at least in my mind) that I want to stop breathing. So I don't let myself get careless with the Wellbutrin.
2. I have an amazing therapist. Therapy has been crucial. That relationship has, bit by bit and piece by piece, played the larges role in wounds healing, rugged scars softening, and my learning to take risks in trusting others. My T had to push and push and push before I ever ventured out of my cave. T tried to get me to *do* things with people - but I dug in my heels and T eventually settled for getting me to promise to make one phone call to one old friend. It took me two weeks to muster up the energy to do it, and T was quite celebratory when I made that first phone call. Point is, that it was within that therapeutic relationship, including the negotiations about my venturing out.. where I repeatedly experienced myself as understood, cared for, believed in.. and eventually I dared to allow myself to become attached.. which enabled me to explore outside that relationship. I was quite broken. Once I really started to improve.. at times I thought I could 'let go' of therapy.. but I have learned that my progress at this point is still rooted in the safety of that relationship. My T compares it to the toddler who - as they rush off to explore their world, they look back to make sure Mom is still there - and the minute something goes wrong, they dart back to home base to regroup. That's kind of what therapy is like for me at this point.. but the good news is that I don't go into isolation very often. Rather, I engage with the world around me - and therapy is where I figure things out if I get overwhelmed. Don't know what I'd do without it.
3. Professionally, I was in a field hard-hit by the recession. As a result, I was laid off two years ago. I knew I had to find another field - so I went back to college and entered the medical field. That forced me out of my cave and forced me to engage with people. My therapist always wanted to know Everything.. and as a result, T would *make* me look at the successes. I haven't been able to get away with making global negative statements of assessment about myself. So I think it has helped me a lot that I had no choice but to engage. You may want to find something to 'obligate' yourself to that will require you to be engaged with others. In retrospect, I have to laugh at how I did it. I did my first semester entirely online. My was therapist expressed a lot of disappointment.. but capitalized on the fact that I at least had to communicate online and by email with instructors and other students. The next semester, I *wanted* to be online only.. but some classes I had no choice but to do on campus. T was thrilled with that. From there, I had to do the rest 100% on-campus. I think it helped me to do it gradually (being around others).I no longer have adhedonia, but I wouldn't characterize myself as being at 100% of where I was before with feeling emotions. My feelings are still somewhat subdued, and my passion is much more moderate, but it's way better than it was four years ago.
Solstice
Posted by bleauberry on September 2, 2011, at 17:43:06
In reply to med help/suggestions/advice/does it get better?, posted by JohnLA on September 2, 2011, at 0:57:07
I totally understand your situation and I'm sure everyone here can relate to it. You aren't alone in what is happening to you.
I'm not a fan of remeron except as a sleep med. It has a flawed journey all the way from its invention to now. Effexor....I can understand your reluctance because yes it usually has nasty withdrawals if it doesn't work, can sometimes make you worse, could certainly cause more apathy. On the bright side, it combines well with remeron....not always but often enough to at least give it a look. Being sensitive you would probably want to go with the immediate release version so you can customize your doses throughout the day. You don't need extended release and in fact the lowest dose of that version might be too much for a sensitive person. Since the other meds....cymbata, celexa, and even ect....didn't work, effexor doesn't really have a whole lot more to offer than those had.
Here's something interesting for you to ponder. I too had failed ECT, bilateral, and I had been through a backpack of failed meds prior to that, hospitalization, everything. Well, guess what actually did work after all that?.....milnacipran (savella). I'm not making any judgements here, just saying it the way it is and I cannot offer an explanation. I've also tried other meds since then and there are only a few I find helpful....
Ritalin
Milnacipran
Amisulpride
VicadinIt's hard to draw conclusions, but hey, you and I have some stuff in common.
Here's what I think would be your best strategy....
Do some probing and experimenting to narrow in on which chemistry is mostly involved with you.For example, to rule in or rule out serotronin, you need to try some ultra low dose 5htp and then tryptophan. If they feel bad or don't do anything, that's cool, now you just ruled out a whole bunch of meds that involve heavy serotonin action including effexor. Moving on, now we want to try DLPA and then tyrosine....trying to see if the norepinephrine/dopamine circuits are involved. You'll either experience good, bad, or nothing. Either way, it tell you a lot. Next on to the most overlooked of them all....the endorphins. You will want to try at least one day of Vicadin. That single day will tell you what you need to know, no matter how it goes.
Ok now fast forward into the future and you've done some probing and experimenting. Now you have some clues to better pinpoint your choices of meds and/or supplements and/or herbs. For example if you had a great response to Vicadin but not the others, then you can pretty much toss out all the psychiatric meds and instead go straight to the herb Rhodiola Rosea.
Actually now that I mention it, no matter what circuit is involved, Rhodiola is a strong candidate. So there's my advice for whatever it is worth....try Rhodiola before you go to the pdoc for a prescription. At the very least, try some stuff as if you were a detective so that when you do go to the pdoc you can be very specific about what you want and why. There are still no guarantees, but at least you have increased your chances of success greatly. It makes more sense to me than shooting while blindfolded.
What's one of the top symptoms of Lyme disease? Depression. Sometimes without any other common lyme symptoms. That can also be ruled in or ruled out with some simple anti-lyme herbs. Or antimicrobial herbs to rule in or rule out any kind of pathogenic organism as the cause of your brain turmoil. A common diagnosis goes like this....feel better than in a long time within a short time after starting, but then quickly deteriorate into worse than before. That is diagnostic.
Just some stuff to think about. The more clues we can gather, the better our chances in the pdoc office to make a right choice.
Ok so let's say you and I are standing outside the pdoc's door and he is about to call you in. You ask me if you should ask for effexor. My answer would be no, ask for milnacipran instead.
But everything else I've said here is more important than that. Just wanted to put my thoughts clearly on the table.
Posted by creepy on September 2, 2011, at 18:26:16
In reply to Re: med help/suggestions/advice/does it get better? » JohnLA, posted by Solstice on September 2, 2011, at 16:16:41
This was an awesome post, thank you. Your therapist sounds really good! Wish mine pushed me that hard sometimes.
Posted by jono_in_adelaide on September 2, 2011, at 20:08:43
In reply to med help/suggestions/advice/does it get better?, posted by JohnLA on September 2, 2011, at 0:57:07
Ask your doctor if you can add either efexor 150mg or Cymbalta 60mg per day to the Remeron - this is coloquialy known amoung psychiatrists as "califirnian rocket fuel" and is said to be very good for resistant depression.
Seeing a psychologist for some CBT would also be a great idea - its unusual for pills alone or therapy alone to be the answer, but the combination of pills AND therapy can be very good
Posted by emmanuel98 on September 2, 2011, at 20:27:56
In reply to med help/suggestions/advice/does it get better?, posted by JohnLA on September 2, 2011, at 0:57:07
Parnate pulled me out of a vegetative state I had been in for a few months. I've been on it two years and haven't gone back to that state, though I've had some severe depressions. I even tried bilateral ECT, which didn't help but blew giant holes in my memory. Ultimately, working hard with a DBT therapist is helping me. Learning to fight depression, distract, do the opposite, stay in the moment. I've been working on nothing but this for three months and have gotten noticeable better.
Posted by Phillipa on September 2, 2011, at 21:04:33
In reply to Re: med help/suggestions/advice/does it get better?, posted by Lepus on September 2, 2011, at 14:35:19
Thanks was a pdoc and the review said the doc wouldn't give her any meds although other docs said she needed them. He told her to get another doc. Had two people look at the names. Both liked the credentials and age of the doc. Seems if not personally involved easier to do. Sorry again. Phillipa
Posted by Phillipa on September 2, 2011, at 21:28:48
In reply to Re: med help/suggestions/advice/does it get better?, posted by emmanuel98 on September 2, 2011, at 20:27:56
And always see a doc if feeling depressed don't self treat. Also psych testing might help? Phillipa
Posted by Solstice on September 3, 2011, at 10:25:04
In reply to Re: med help/suggestions/advice/does it get better?, posted by creepy on September 2, 2011, at 18:26:16
> This was an awesome post, thank you. Your therapist sounds really good! Wish mine pushed me that hard sometimes.
I'm honored if something I said was helpful to you, Creepy :-)
It's interesting to me in retrospect, but my therapist and I had some struggles over the pushing issue. T pushed, and I resisted. Strongly. Early on, I felt pushed beyond what I was able to cooperate with. I would brood over it between sessions.
One of the most transforming (for me) things about therapy for me, is that from the beginning, T told me "if there is anything that goes on in here that becomes a problem for you, talk to me about it. We will work it out together." So after agonizing and brooding over feeling pushed beyond where I could 'go,' I would eventually object. T would listen reflectively.. and would step back from the pushing. Then, when I gained sturdiness, the pushing would start again. This cycle went on for a couple of years! But the gold in those experiences is that without fail, T listened to my objections. T repeatedly told me that my sense of myself and my needs would always supercede. The repeated experiences I had with being 'allowed' to object, being heard, T responding to my objections by stepping back.. all of that forged a deep attachment. I felt so safe. Whereas before therapy I was very reluctant to respect my own instincts, from these experiences I learned how to listen to and stand by my instincts. T and I have talked a lot during the last year about *who* is responsible for my progress. Both T and I agree that it's primarily been in my hands.. but I insist that T's responsiveness and therapeutic instincts have been the lubrication that kept the gears in operation :-) It truly is a joint effort. I hope that T takes joy in my healing, and that participating in my healing is at least as enriching as the financial compensation.
Sol
Posted by JohnLA on September 23, 2011, at 20:45:28
In reply to Re: med help/suggestions/advice/does it get better? » creepy, posted by Solstice on September 3, 2011, at 10:25:04
forgot to thank you all for the suggestions.
i lasted 5 days on effexor xr. not a real trial i know, but i felt horrendous (physically) and said screw-it.
thanks again for the advice/encouragement.
john
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