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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by Petrucci914 on January 27, 2009, at 17:04:34
Hello everyone,
I'm new here. I've been suffering from Atypical Depression for about 4-5 years with these prominent symptoms:
1. Oversleeping
2. Lethargy/Lack of energy
3. Overeating
4. Generalized Anxiety
I've been on the following medications:Zoloft, Effexor, Lexapro, Cymbalta, EMSAM, Abilify, Wellbutrin, Provigil, Strattera, Lamictal, Provigil, Pristiq
Nothing has really helped me. Wellbutrin worked great for about 4 months and then pooped out. Lamictal helped a lot for about one week and then just let to brain fog. Provigil either helped me a lot, did nothing, or made me extremely suicidal (which I'm normally not).
I know MAOIs are recommended in my situation but some people tell me not to go that route. I'm also into the Craft Beer scene and if I go on an MAOI I can basically throw that social aspect of my life goodbye. I wanted to try a stimulant (Adderall XR/Vyvanse or Ritalin ER/Concerta) but my doctor doesn't want to prescribe stimulants.
Any recommendations?
I also take B-Vitamins, Omega-3s
Posted by SLS on January 28, 2009, at 8:25:05
In reply to How to defeat Atypical Depression?, posted by Petrucci914 on January 27, 2009, at 17:04:34
Did you try combining Wellbutrin 300mg and Lamictal 200mg? My doctor and his colleagues feel it is a particularly useful treatment.
Is there any history of bipolar disorder in the family?
Lamictal gives me cognitive impairments at dosages of 250mg and above.
- Scott
Posted by Petrucci914 on January 28, 2009, at 9:39:25
In reply to Re: How to defeat Atypical Depression?, posted by SLS on January 28, 2009, at 8:25:05
> Did you try combining Wellbutrin 300mg and Lamictal 200mg? My doctor and his colleagues feel it is a particularly useful treatment.
>
> Is there any history of bipolar disorder in the family?
>
> Lamictal gives me cognitive impairments at dosages of 250mg and above.
>
>
> - ScottYa, I've been on that.
Wellbutrin used to be great for me but stopped working after 4-5 months and now just does nothing. Lamictal was great once I hit 100mg but then it did nothing after a week. I went up to 200mg and it really did nothing other than give me brain fog.
I'm on Pristiq 50mg right now. I thought about maybe adding Remeron for the 'California Rocket Fuel' but I'm afraid about the sedation, increased appetite, and such....as I already have problems with that already.
Posted by SLS on January 28, 2009, at 13:20:46
In reply to Re: How to defeat Atypical Depression?, posted by Petrucci914 on January 28, 2009, at 9:39:25
> I'm on Pristiq 50mg right now. I thought about maybe adding Remeron for the 'California Rocket Fuel' but I'm afraid about the sedation, increased appetite, and such....as I already have problems with that already.
Both of those unwanted side effects are often mitigated at higher dosages >= 45mg. At these dosages, the pro-norepinephrine actions of Remeron predominate. It also gives a couple of extra squirts of dopamine and norepinephrine in the area of the brain responsible for mood and cognition.
- Scott
Posted by Petrucci914 on January 28, 2009, at 13:52:55
In reply to Re: How to defeat Atypical Depression?, posted by SLS on January 28, 2009, at 13:20:46
> > I'm on Pristiq 50mg right now. I thought about maybe adding Remeron for the 'California Rocket Fuel' but I'm afraid about the sedation, increased appetite, and such....as I already have problems with that already.
>
> Both of those unwanted side effects are often mitigated at higher dosages >= 45mg. At these dosages, the pro-norepinephrine actions of Remeron predominate. It also gives a couple of extra squirts of dopamine and norepinephrine in the area of the brain responsible for mood and cognition.
>
>
> - ScottCan one start Remeron at those higher doses, or do you have to titrate it?
Posted by SLS on January 28, 2009, at 14:04:28
In reply to Re: How to defeat Atypical Depression?, posted by Petrucci914 on January 28, 2009, at 13:52:55
> Can one start Remeron at those higher doses,
Many doctors start at 30mg at night to minimize the sedative and hunger side effects.
Generally, I think American doctors use dosages of Remeron that are too low. I would not stop increasing the dosage until you reach 75mg, as long as you are tolerating it. Get up to 45mg as quickly as you can.
Check out this discussion among doctors:http://www.dr-bob.org/tips/split/Mirtazapine-side-effects.html
- Scott
Posted by Petrucci914 on January 29, 2009, at 20:07:46
In reply to Re: How to defeat Atypical Depression?, posted by SLS on January 28, 2009, at 14:04:28
> > Can one start Remeron at those higher doses,
>
> Many doctors start at 30mg at night to minimize the sedative and hunger side effects.
>
> Generally, I think American doctors use dosages of Remeron that are too low. I would not stop increasing the dosage until you reach 75mg, as long as you are tolerating it. Get up to 45mg as quickly as you can.
>
>
> Check out this discussion among doctors:
>
> http://www.dr-bob.org/tips/split/Mirtazapine-side-effects.html
>
>
> - ScottThank you for that.
When going on 'California Rocket Fuel' do I need to monitor myself for Serotonin Syndrome? I read that Remeron does not have the potential for Sertonin Toxicity either from overdose, or dual-action drugs, and that this is why it is safe.
Thanks, again!
Posted by NewQuestions on February 6, 2009, at 16:22:47
In reply to Re: How to defeat Atypical Depression?, posted by Petrucci914 on January 29, 2009, at 20:07:46
You don't always need drugs. Sometimes your depression is purely psychological or environmental.
Your lack of response to the typical drugs may indicate bipolarity. It could also be a hormone thing. Have you gotten blood tests?I used to believe in drugs. I don't anymore. Drugs only work for so long. Then you are back to where you started. Figuring out natural coping mechanisms, whether its biofeedback, yoga, therapy, a change in environment, may be more viable longterm.
Posted by Petrucci914 on February 6, 2009, at 16:34:57
In reply to Re: How to defeat Atypical Depression?, posted by NewQuestions on February 6, 2009, at 16:22:47
> You don't always need drugs. Sometimes your depression is purely psychological or environmental.
> Your lack of response to the typical drugs may indicate bipolarity. It could also be a hormone thing. Have you gotten blood tests?
>
> I used to believe in drugs. I don't anymore. Drugs only work for so long. Then you are back to where you started. Figuring out natural coping mechanisms, whether its biofeedback, yoga, therapy, a change in environment, may be more viable longterm.
I've gotten blood tests done. I had all thyroid tests done twice within a year, those were all within normal. I've gotten several sleep tests and those were normal.I was on Lamictal and it helped for about a week, then it just led to brain fog. I don't know about BP.....seems like most of my symptoms are for Atypical Depression or Dysthymia.
A few meds have helped here and there, but my anxiety was always there. Not sure if anxiety could be responsible for all my symptoms.
I'm at a loss for what to do.
Posted by JadeKelly on February 12, 2009, at 17:33:22
In reply to Re: How to defeat Atypical Depression?, posted by Petrucci914 on February 6, 2009, at 16:34:57
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Posted by n_wolfie on June 13, 2009, at 21:55:30
In reply to Re: How to defeat Atypical Depression?, posted by SLS on January 28, 2009, at 8:25:05
Scott did you go off the Lamictal completely? I wish it hadn't stoppped working, it was the most effective medication I had ever used, at this time last year I felt better than well. I had a sinking feeling at the time that it was too good to be true. Does anyone ever recover permanently from depression?
Posted by n_wolfie on June 13, 2009, at 21:56:38
In reply to Re: How to defeat Atypical Depression?, posted by Petrucci914 on February 6, 2009, at 16:34:57
Have you tried Nardil? Took years before I found a doctor who would prescribe it and it was very effective. It's the only med that's really worked long term for me.
Posted by n_wolfie on June 13, 2009, at 21:57:44
In reply to Re: How to defeat Atypical Depression?, posted by SLS on January 28, 2009, at 13:20:46
Scott how are you doing on the Remeron? Do you suffer from atypical?
Posted by SLS on June 14, 2009, at 4:18:56
In reply to Re: How to defeat Atypical Depression?, posted by n_wolfie on June 13, 2009, at 21:55:30
> Scott did you go off the Lamictal completely?
I don't do very well when I attempt to discontinue Lamictal, even gradually. It produces only a mild improvement, but only when I take it with other drugs.
> I wish it hadn't stoppped working, it was the most effective medication I had ever used, at this time last year I felt better than well.You might want to try adding Wellbutrin (buproprion, amphebutamone). The combination seems to be particularly effective according to my doctor.
> Does anyone ever recover permanently from depression?
It happens far more often that what we see here at Psych-Babble. Usually, only treatment non-responders arrive here, so treatment resistence is the rule rather than the exception. There are people who started out with recurrent or chronic depressions whom have been kept well for decades. You might have to make periodic changes in your treatment regime to maintain an optimal antidepressant response.
- Scott
Posted by SLS on June 14, 2009, at 4:22:07
In reply to Re: How to defeat Atypical Depression?, posted by n_wolfie on June 13, 2009, at 21:57:44
Hi.
I suffer from an unusual form of bipolar depression that never relents and is peppered with drug-induced manic reactions. It appears very similar to atypical depression.
I am currently taking:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
Topamax 75mg
- Scott
Posted by n_wolfie on June 14, 2009, at 7:19:34
In reply to Re: How to defeat Atypical Depression? » n_wolfie, posted by SLS on June 14, 2009, at 4:18:56
Do you mean wellbutrin in addition to the lamictal and nardil? So now that I've started the Lamictal, I probably won't ever be able to discontinue it, even if I was ok without it before? Well, I think it does something.. but I'd like to be on as few meds as possible. Getting down to 200 is not going to be fun.
Posted by FredPotter on August 13, 2009, at 20:02:36
In reply to Re: How to defeat Atypical Depression? » n_wolfie, posted by SLS on June 14, 2009, at 4:18:56
Scott you're absolutely right. When Nardil bedded in I started feeling well and at times better than well. I adored being around people. I may have been a bit over the top. It was really the sexual side-effects and weight gain that made me change to Parnate. Anyway I didn't come on Babble from one month to the next. Selfish really. But I didn't want to be reminded of it. Now I'm waiting for Parnate to bed in (I'm in week 5 it's not as quick as I'd hoped) and if it does I expect I'll disappear again
Posted by creepy on October 7, 2009, at 15:27:59
In reply to How to defeat Atypical Depression?, posted by Petrucci914 on January 27, 2009, at 17:04:34
Im also atypical depressive and Ive tried a few things, recently a TCA. Any remission I get is short-lived.
I think the answer is MAOIs unfortunately.
I see someone else mentioned parnate already.
My symptoms are exactly the same. I notice that I have a pattern of doing better on stimulating meds. I also drink a lot of diet soda and wonder if its the phenylalanine that my body is looking for. I might try low-dose selegiline first and see if the dopamine / PEA is enough.
Posted by catstretch on October 13, 2009, at 8:20:11
In reply to Re: How to defeat Atypical Depression? » n_wolfie, posted by SLS on June 14, 2009, at 4:22:07
Just to clarify something, Atypical Features aren't limited to just depression. They can also be found in Bipolar, especially Bipolar II, and Dysthymia.
Posted by catstretch on October 13, 2009, at 8:27:04
In reply to Re: How to defeat Atypical Depression?, posted by creepy on October 7, 2009, at 15:27:59
Do you have rejection sensitivity/emotional lability as one of your symptoms? Parnate seems to work better when that is the case. Some other important variables are age of onset (late adolescence?) and whether it is chronic and unremitting or goes in phases. People seem to respond better to MAOIs in the former cases.
Atypical depression is a tricky thing because the research is pretty clear that at least two different symptom clusters are combined in the one general category. It seems likely that one of the subcategories is uniquely responsive to MAOIs, but individuals who have the diagnosis as a whole aren't necessarily.
The category was also originally characterized by anxiety, so that might be plus in your case. The MAOIs seem to have some anxiolytic properties.
Posted by creepy on November 2, 2009, at 13:37:37
In reply to Re: How to defeat Atypical Depression?, posted by catstretch on October 13, 2009, at 8:27:04
Im going to try to get my doc to start me on parnate if this TCA trial bombs which im pretty sure its going to.
He wants to try effexor but Im already on SSRI + TCA so I doubt thats going to help things.
Posted by fattoush on November 24, 2009, at 3:44:47
In reply to Re: How to defeat Atypical Depression?, posted by creepy on October 7, 2009, at 15:27:59
You say MAOIs unfortunately. I was on MAOIs for months. It's really no big deal, and they are very effective according to many. I was on Emsam and gradually went up to 12 mgs. My problem was that then they did not know I was bipolar II, and boy did I flip! I had a lot of the fun you have that is very dangerous without protection. But I did use protection.
By the way, isn't Atypical usually contrasted with Melancholy, which happens at its worst in the morning?
Posted by Ivo_M on January 14, 2010, at 15:52:56
In reply to How to defeat Atypical Depression?, posted by Petrucci914 on January 27, 2009, at 17:04:34
I have unipolar atypical depression/dysthymia for over 20 years with symptoms similar to yours. I can exactly remember the time when i noticed my mood switch from normal to depressed/dysthymic and how different I was before that.
So far I have tried clomipramine, maprotiline, two kinds of SSRI-s, amitriptyline, wellbutrin + T3 hormone, and venlafaxine. Clomipramine wast the first I got and it was some effect. I had better, but only partial, success with amitriptyline and took it for 4-5 years. All others were either ineffective or had too bad side effects - mostly decreased libido. Most SSSR-is made me just feeling blunt and had disastrous effect on my already decreased libido. I got chest pain from wellbutrin and it also made me nervous so I had to stop using it.
I think that problem lies in the fact that almost all antidepressants increase neurotransmiters serotonin or norepinephrine. There is no effective antidepressant that increases dopamine. Dopamine is the neurotransmitter which influences motivation and reward, sleep, mood, attention, learning, sex drive, and other functions. It's possible that downregulation of dapaminergic pathways might be the cause of unipolar atypical depression/dysthymia. For instance, after overstimulation of dopamine receptors with stimulants like amphetamine a withdrawal crisis develops with symptoms similar to depression.
The only effective antidepressant that stimulated dopeminergic pathways was amineptine. It was a French drug, and it was very effective in large percent of patients. In contrast to most antidepressants it didn't decrease sex drive, but did the opposite. As a dopamine stimulant it had some potential of abuse but it was rather mild. However, under the pressure of FDA it was declared as potentially abusive and it was withdrawn from the markets all around the world. The fact is it was simply too effective and cheap and as such it was a strong competition for the US big pharma industry which spent hundreds of millions for the development and marketing of SSRIs. There are many other drugs with much higher abuse potential but they are manufactured by the US big pharma and they never got withdrawn from the market.
There is one drug with action similar to amineptine but it's not antidepressant, its an antipsychotic. Amisulpride (Solian) is used for treatment of schizophrenia in doses of a few hundreds mg per day. In such doses it works as dopamine antagonist (schizophrenia is caused by excess of dopamine). But in small doses (up to 50 mg per day) it has the opposite effect - it works as dopamine agonist (i.e. stimulant). It's been proven to be effective for depression/dysthymia in 50-60% of cases in doses of up to 50 mg/day. However, it has a serious drawback - in some patients it can increase hormone prolactin, which in turn decreases sex drive, and can be harmful over prolonged period of time. Prolactin increase happens more often in female patients than in men. It might also cause other serious side effects, like tardive dyskinesia, but as far as I understand it's more likely to happen with doses used for schizophrenia.
Some users of this forum have been using it for two or more years with good results. I still haven't tried it myself but I'm considering it.
Here are some links:
http://www.dr-bob.org/babble/20010515/msgs/63723.html
http://www.ncbi.nlm.nih.gov/pubmed/9892856
http://www.ncbi.nlm.nih.gov/pubmed/9495601
http://www.ncbi.nlm.nih.gov/pubmed/10512080
http://www.ncbi.nlm.nih.gov/pubmed/11712619
Posted by Deneb on January 15, 2010, at 1:12:38
In reply to Re: How to defeat Atypical Depression?, posted by Ivo_M on January 14, 2010, at 15:52:56
Hello Ivo_M!
Welcome to Psycho-Babble! Thanks for that information about Amisulpride. I think it will help a lot of people. I hope you find something that works!
Deneb
Posted by desolationrower on January 24, 2010, at 19:19:38
In reply to Re: How to defeat Atypical Depression? » Ivo_M, posted by Deneb on January 15, 2010, at 1:12:38
MAOIs, bupropion, DA agonists, even low-dose of neuroleptics all work on dopamine.
i think amineptine is a good drug, though
-d/r
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