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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by jono_in_adelaide on October 9, 2012, at 18:40:41
I'm starting to see some evidence that psychiatry is again, after a 25 year break, begining to unerstand that theres more than one type of depression
-atypical/reactive/anxious/neurotic - responds well to SSRI's or failing that an MAOI
-endrogenous/biological/melancholic/psychotic - responds well to an NARI or TCA, failing that at NARI + an SSRI
Unfortunatly too many PCP's still think depression = SSRI, and when that doesnt work, they are stumped as to what to do next.
Hopefully the messages trickles down fast!
I had a deep endrogenous depression, and SSRIs did absolutly nothing, it was only my reading on the net that led me to ask (insist) on a trial of adding nortriptyline to the SSRI, and when I did, within five days I could feel my self getting better.
Posted by SLS on October 9, 2012, at 19:09:49
In reply to Depression comes full circle, posted by jono_in_adelaide on October 9, 2012, at 18:40:41
Your subject line scared me. I thought you had relapsed!
I'm glad to know that this is not the case.
I hope you are right about clinicians returning to the notion that "depression" represents a heterogenous array of clinical and biological presentations that requires different treatment regimes.
- Scott
Posted by jono_in_adelaide on October 9, 2012, at 19:32:37
In reply to Re: Depression comes full circle » jono_in_adelaide, posted by SLS on October 9, 2012, at 19:09:49
No, thank christ..... the cocktail of Edronax and Zoloft keeps the black dog at bay for me...... my anxiety still needs some work, but I have a plan for that (sort of)
Worst case of bad prescribing i ever saw was a guy who worked for me, his wife walked out and left him with 3 kids.... 3 days later he began to itch uncontrolabley all over his body..... he went to a doctor, and came out with a script for Zoloft, one months supply and 5 refils.
I seriously doubt six months on an SSRI was the appropriate treatment in this case..... maybe a couple of weeks of Atarax or Sinequan, maybe a few days worth of Valium, but six months of an SSRI for stress induced itching as ai initial response reaqly flawed me
Posted by ChicagoKat on October 9, 2012, at 21:05:26
In reply to Depression comes full circle, posted by jono_in_adelaide on October 9, 2012, at 18:40:41
> I'm starting to see some evidence that psychiatry is again, after a 25 year break, begining to unerstand that theres more than one type of depression
>
> -atypical/reactive/anxious/neurotic - responds well to SSRI's or failing that an MAOI
>
> -endrogenous/biological/melancholic/psychotic - responds well to an NARI or TCA, failing that at NARI + an SSRI
>
> Unfortunatly too many PCP's still think depression = SSRI, and when that doesnt work, they are stumped as to what to do next.
>
> Hopefully the messages trickles down fast!
>
> I had a deep endrogenous depression, and SSRIs did absolutly nothing, it was only my reading on the net that led me to ask (insist) on a trial of adding nortriptyline to the SSRI, and when I did, within five days I could feel my self getting better.Interesting post. Cos I've been told I'm an atypical/reactive type, and I responded really well to SSRIs til they pooped out on me. And look at how well I'm responding to an MAOI now. And I'm really glad the Nortryptiline has helped you, but it may explain why it did not do much for me.
Posted by ChicagoKat on October 9, 2012, at 21:08:41
In reply to Re: Depression comes full circle, posted by jono_in_adelaide on October 9, 2012, at 19:32:37
> No, thank christ..... the cocktail of Edronax and Zoloft keeps the black dog at bay for me...... my anxiety still needs some work, but I have a plan for that (sort of)
>
> Worst case of bad prescribing i ever saw was a guy who worked for me, his wife walked out and left him with 3 kids.... 3 days later he began to itch uncontrolabley all over his body..... he went to a doctor, and came out with a script for Zoloft, one months supply and 5 refils.
>
> I seriously doubt six months on an SSRI was the appropriate treatment in this case..... maybe a couple of weeks of Atarax or Sinequan, maybe a few days worth of Valium, but six months of an SSRI for stress induced itching as ai initial response reaqly flawed meThat is the sort of story that scares the crap out of me about some docs. there are definitely some very bad ones out there. but, I always hope, it's most likely a case of there always being a few bad apples in the bunch.
Posted by Christ_empowered on October 9, 2012, at 22:02:01
In reply to Re: Depression comes full circle » jono_in_adelaide, posted by ChicagoKat on October 9, 2012, at 21:08:41
stuff like that happens in the US all the time. I saw on the TV news that 10% of the population is on at least one antidepressant, and many of those people don't even meet the criteria for depression (which is pretty lax these days, anyway).Scary.
Posted by gilmourr on October 9, 2012, at 22:25:42
In reply to Re: Depression comes full circle » jono_in_adelaide, posted by ChicagoKat on October 9, 2012, at 21:08:41
That is really interesting..
I've never tried a TCA (clomip, imip, amitryp or nortryp). I've also never tried a NARI.
I've only tried SSRI's and MAOI's. (6 of them and 2 maoi's).
Why do you think TCA's/NARI's are good for endogenous depression? I have VERYRYYRYRYRYR endogenous depression + anxiety. I need some good evidence to leave nardil and try something like clomip or imip
Posted by phillipa on October 9, 2012, at 22:57:28
In reply to Re: Depression comes full circle, posted by gilmourr on October 9, 2012, at 22:25:42
We are all different and what works for one may not neccesarily work for another. Scott how is your trial going? Phillipa
Posted by JONO_IN_ADELAIDE on October 9, 2012, at 23:17:03
In reply to Re: Depression comes full circle, posted by phillipa on October 9, 2012, at 22:57:28
Hi Gillmore
The TCA's and other NARI's work so well in endrogenous depression because the main chemical abnormality in this type is with the noradrenalin system, where as in reactive or atypical depressions seretonin plays the bigger role.
There is alwats the option of hitting severe depression with the "one-two knockut punch" of an SSRI such as sertaline and an NARI such as nortriptyline, bupropion or reboxetine, the two together can be very helpful, the NARI helps the endrogenous stuff, the SSRI helps the anxiety symptom cluster.
Posted by gilmourr on October 11, 2012, at 2:32:55
In reply to Re: Depression comes full circle-Gillmore, posted by JONO_IN_ADELAIDE on October 9, 2012, at 23:17:03
So what would you recommend? I've tried celexa, lexapro, paxil, prozac, zoloft, nardil, remeron, parnate, effexor XR, cymbalta, seroquel, trazadone, xanax, klonopin, ativan and valium
The only things that have worked are..
Zoloft and Nardil. Zoloft didn't work the second time I went on it though after 4 weeks. Maybe it needed longer, but I felt like I was going to kill myself so I went back on Nardil. Zoloft doesn't work as well, but way less side effects. Nardil works better, more side effects.
Klonopin is the only benzo that works well I'd say on my anxiety. Seroquel is an incredible sleep aid. I'm just afraid that I need GABA in my system that Nardil provides.
I would probably want the TCA to be the more powerful one. So I think I'd use clomipramine or imipramine. Then add wellbutrin? It's so hypothetical though..
Posted by gilmourr on October 11, 2012, at 2:34:43
In reply to Re: Depression comes full circle-Gillmore, posted by JONO_IN_ADELAIDE on October 9, 2012, at 23:17:03
I still think I'd prefer adding nortryptiline to Nardil.
I just can't get a doctor to do that. And no internet websites ship to Canada since our customs are tight.
Posted by phidippus on October 12, 2012, at 17:40:56
In reply to Depression comes full circle, posted by jono_in_adelaide on October 9, 2012, at 18:40:41
5 days!!! Stunning!
Eric
Posted by jono_in_adelaide on October 14, 2012, at 23:06:21
In reply to Re: Depression comes full circle » jono_in_adelaide, posted by phidippus on October 12, 2012, at 17:40:56
I know Eric, I was amazed, and very happy!
The relief!!
Now just gotta lick that anxiety
Posted by jono_in_adelaide on October 14, 2012, at 23:07:27
In reply to Re: Depression comes full circle-Gillmore, posted by gilmourr on October 11, 2012, at 2:34:43
http://www.internationalpharmacy.com/en/products/search/nortriptyline/1
This likk isnt suggesting you buy this drug from this or any other grey market source, its for novelty value only
Posted by phidippus on October 15, 2012, at 13:38:34
In reply to Re: Depression comes full circle, posted by jono_in_adelaide on October 14, 2012, at 23:06:21
best way is to treat with an antidepressant.
Eric
Posted by gilmourr on October 16, 2012, at 9:31:49
In reply to Re: Depression comes full circle-Gillmore, posted by gilmourr on October 11, 2012, at 2:34:43
I forgot to say, I saw my GP again like always and like for the billionth time I showed him pdf's and medical journals for a TCA and MAOI and he actually gave it to me this time!
Thing is, my MAOI hasn't returned back to normal since coming down from 60 mg yet to 45 mg (which is always my golden dosage). 60 mg f*ck*d stuff up and I was waiting for it to balance out, but it isn't...
So now I'm not sure, wait 1-2 weeks more max and if it doesn't work what do I do? Start the best SSRI for me + nortryp, restart the MAOI (it's worked 2/2 when I start it from 0, it just isn't the same when I go from 60 to 45 mg..like right now I actually feel pretty f*ck*ng depressed. Which never happens on nardil 45. And I've been taking nardil 45 mg for like 38 days now
Posted by phidippus on October 16, 2012, at 11:25:04
In reply to Re: Depression comes full circle-Gillmore, posted by gilmourr on October 16, 2012, at 9:31:49
>if it doesn't work what do I do?
Isn't there another MAOI you can start?
Eric
Posted by gilmourr on October 17, 2012, at 13:32:14
In reply to Re: Depression comes full circle-Gillmore » gilmourr, posted by phidippus on October 16, 2012, at 11:25:04
Tried Parnate, it caused 100% remission for 48 hours then it stopped and for the next 30 days after I felt like I had hypothermia, I was completely dead, weak, couldn't think, it was like I was given 2 days of remission for a tradeoff of weeks of sh*t times.
Parnate is a no go. Moclobemide is reversible so it doesn't seem worth it
Posted by phidippus on October 17, 2012, at 16:07:12
In reply to Re: Depression comes full circle-Gillmore, posted by gilmourr on October 17, 2012, at 13:32:14
I heard Moclobemide can be worth a go. My shrink offered it to me.
Eric
Posted by gilmourr on October 18, 2012, at 10:40:34
In reply to Re: Depression comes full circle-Gillmore » gilmourr, posted by phidippus on October 17, 2012, at 16:07:12
I just don't understand how a reversible MAO can be helpful if MAO isn't inhibited.
I'm definitely going to exhaust all my options but the first thing that's on my mind is nardil + nortryp since I think that has a chance of getting me back to being good enough to leave all these forums and start working/school being completely normal again.
It looks like I'll be going down the list like this...
1) Nardil + nortryp
2) Imipramine
3) Moclob or pristiq.
This is the end of the thread.
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