Posted by SLS on March 17, 2001, at 10:32:56
In reply to Re: treatment resistant depression » SLS, posted by sweetmarie on March 15, 2001, at 12:44:29
Hi Anna.
> I know that both Epilim and Lamotragine are mood stabilisers, and to be quite honest, I`m not entirely sure why I am taking both. As I said, there has never been a hint from any doctor that my condition might be Bipolar. The Epilim replaced Lithium as an `augmentation`, and the Lamotragine was prescribed about 6 months later. The ony reason that I was prescribed Lamotragine was that another of my psychiatrist`s patients had read of it on the Net. She had tried it, and it had worked miracles. So, this is the only basis for me going onto Lamotragine
I am really interested to know to what extent doctors are having success using lamotrigine in true unipolar depression. I would also like to know if there are differences in the success rate among some of the depressive subtypes: melancholic, atypical, dysthymic, anergic, agitated, and psychotic.
> I think basically, she was clutching at straws, and this combination (Epilim, Lamotragine, Trimipramine and Phenelzine) was more of a `mish-mash` than anything else. It was when this failed to work that she referred me to the specialist (who has subsequently assessed me, given me a diagnosis, and I will be under his care when I go into his hospital - not my local one - in about a months time. I guess that this answers your question about the Epilim/Lactimal combination (i.e. it didn`t help me at all, but a) I was on a very small dose of Lactimal (25 mg, which will now be going up to 250 mg), and b) these treatments are very individual (what didn`t work for me, may work for you).
It is good that your doctors are willing to go to 200mg and higher with lamotrigine right away. Personally, I need 300mg to glean the mild improvement it gives me. Lamotrigine can produce an initial improvement with dosages as low as 25mg, but higher dosages are usually needed to make it stick.
> > > and I`ve suffered to differing degrees (from moderate to severe) most of my life.
> > I get pissed whenever I have to read a story like yours. Damn it.
> Is that because you`ve had a similar experience? From what you`ve said, it sounds like it.
Yes. I get upset whenever I see that someone has to suffer so much depression for so long as to completely destroy their lives in the manner it has destroyed mine. Your description of life with depression is so much like my own. I think I get more pissed reading of someone else's misery that I do for my own.
> > > How long have you been depressed?> > With the exception of a 6-month remission brought about by a combination of antidepressants, 24 years.
> What happened after the 6 month remission - did you discontinue the treatment, or did the effect simply wear off?
I was made well using a combination of antidepressents comprised of Parnate and desipramine (Norpramin). After six months or so of euthymia (good mood), I began to develop a hypomania that continued to develop into a mixed-state or dysphoric psychotic mania. As seems to be common sense, my doctor discontinued the antidepressants and gave me lithium and eventually Klonopin (clonazepam) to relieve the mania. After two months of continued remission without antidepressants, I relapsed. Unfortunately, Prozac had just been approved. I guess my doctor wanted to play with a new toy. It didn't work, although I doubt he would have exceeded a dosage of 20mg. After discontinuing Prozac, my doctor decided to return to Parnate, only without the desipramine. He had some notion that the "terrain" of the brain had changed, and that a combination was not necessary. I imagine he was also reluctant to restart the drug regiment that caused mania. He was too stubborn. He spent almost three months trying to force Parnate to work by changing the dosage up and down. To make a long story short, the original combination never worked again. And thus the continued odyssey...
> 24 years is a long time - has it been severe ALL that time?
Yes. I was a junior in highschool at age 17 when the severe depression swallowed me up. It came over me within an hour. It was as paroxsymal as the mood switches that occur with ultra rapid-cycling presentations. Actually, I displayed a robust ultra rapid cycle that comprised of 8 days of depression followed by 3 days of euthymia, followed by 8 days of depression, etc. The switch from one state to the other occurred over the course of 30 to 45 minutes. So too was my initial switch into severe depression. It is important to note that I experienced episodic mild to moderate depressive episodes beginning at age 10 or 11.
> How old are you?
41 years young.
> Mind you, I don`t really remember a time when I wasn`t depressed,
:-(
> and I`m 34 now.
All the more reason to persevere. You are plenty young enough to have a wonderful life once you find an effective treatment. I remember being told the same thing when I was 34. I thought this was nothing but placating crap. They were right, though. You might feel like you have tried every drug in every possible combination. However, I think you would be surprised at how many different drug combinations and treatment strategies you have left to try. I believe it is logical for you to have real hope. I wish I were able to always believe it for myself. You are not alone, Anna.
> > > Is it moderate/severe?
> > Severe. (I have been accused of being overly proud of this).
> What do your psych doctors say about your situation? Do they encourage you and say that there will be a `right medication` or `right` combination?
After investing 10 years with the same doctor with little success, he helped me find a doctor with more expertise in treatment resistant cases. This new doctor seems optimistic that a we will find combination drug treatment that will work. Unfortunately, he impressed upon me that it might still take quite a bit of time. He didn't characterize what he meant by "quite a bit", and I didn't want to ask. However, I think I have a good chance with this doctor, so long as I don't sabotage his algorithm by making drug changes on my own.
> Are they sympathetic?
My previous doctor was very sympathetic. My new doctor is very empathetic. I feel as if he genuinely understands the painful non-existence that is the depressed state. He called my condition horrendous and unacceptable. He described how I experience life as being sub-human. It feels like a huge weight lifted off my shoulders to not have to convince a doctor just how bad things are for me. When he used the word "horrendous", I couldn't help but let out a huge sigh of relief and then cry.
> How long have you been on medication treatment?
I was first diagnosed in 1982 by a study team at Columbia-Presbyterian in New York. The three doctors with whom I dealt with directly were Michael Liebowitz, Wilma Harrison, and Frederick Quitkin. As they proceeded through different treatments, I responded for a few weeks to imipramine (a tricyclic like dothiepin) and a few days to Parnate. They were a bit surprised that amphetamine put me to sleep. After nine months, they pretty much gave up on me and told me that I should not look forward to getting well, as they believed that I had exhausted their treatment resources. They felt that my best hope was for psychotherapy, two years of which had already proved useless. Since I was a rapid-cycler at the time, and I experienced such amazing, although short lived, response to a few medications. Their conclusions did not make sense to me. I wish that I had knocked on Ronald Fieve's door on the same floor I was being treated to see what he had to say. After all, it was his book "Mood Swing" that allowed me to recognize my disorder in the first place.
****************
> I have been on different things for the past 10 years now. Only the very first anti-depressant I ever had worked; that was Dothiepin, which I took for a year and I was 100% well. So well in fact that I stopped taking it, and when the symptoms returned I went back onto it. It didn`t work 2nd time around, and I have been kicking myself ever since for coming off it in the first place.
You will find the Psycho-Babble board littered with this same scenario. Anyone thinking of discontinuing a successful treatment may want to take the time to evaluate to what degree the details of their case allow for discontinuation with a low risk for relapse. It is a difficult judgment to make, and 20/20 hindsight is enlightening, but not terribly helpful. Some of the factors that enter into making a decision toward long-term treatment are:
1. Early age of onset
2. Chronicity - an extended period of depression.
3. Recurrent - recurrent or multiple episodes of depression.
4. Bipolar disorder
5. Treatment resistance****************
> Have you tried ECT?
Yes. 6 unilateral left treatments followed by 6 to 8 of bilateral treatments. I experienced some relief after the sixth treatment, but that was about it. This was performed in 1991. I have been advised that there have been significant advances in the application of ECT since then, and that my lack of response cannot be extrapolated to the treatments currently used. I once wrote a letter to Dr. Max Fink, a doctor who has devoted much of his career to ECT. This was his opinion as well.
> I had 20 sessions during one hospital stay, and it did not-all to improve my mood. What it did do though, was to totally wipe out my memory of the previous 18 months. Terrific.
Sigh...
I'm sorry.
Sometimes I just don't know what to think about this whole ECT and memory thing.
> And what about a specialist - have you ever been referred? Have you asked?
If you are referring to a specialist in ECT, the answer is no. My current doctor says that he will bring up the issue from time to time, but will not apply any pressure in that direction.
If you are referring to treatment-resistant specialists, I have seen and have been referred to quite a few. I have seen people in New York, Princeton, Boston, and the NIH in Washington D.C. (Bethesda, Maryland). My doctors have also conferred with many of their colleagues along the way. I think I have been pretty lucky to have had my case considered by so many people. Hopefully, there will not be a need for any more. One thing I have been surprised at on Psycho-Babble is to learn just how many good psychiatrist-psychopharmacologists can be found everywhere. New York does not have a lock on expertise. Some really good doctors can be found just around the corner from McDonald's.
> - it is truly a hideous illness.
I figured it was worth printing your quote one more time.
Dear Anna,
I hope you have hope. Like I said before, it is logical that you should. There is so much to be had by just reading about all of the success stories here and the details of what treatments worked. For me, this is the most important function of Psycho-Babble because it shows me just how many possibilities I have not yet encountered or have given serious considration to. There are many, many bright and creative people here who care enough to be willing to share information and personal experiences. Thank you for being one of them.
- Scott
poster:SLS
thread:55847
URL: http://www.dr-bob.org/babble/20010310/msgs/56746.html