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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Adam on September 27, 2001, at 21:10:33
A while ago, I quit selegiline cold turkey because I needed to get some tests for an as-of-yet undiagnosed medical condition. Well, I should qualify that: I don't agree with one doctor's diagnosis, at least at this juncture, and have been persistant about exploring the physiological rather than the psychological aspects of my symptoms. I still don't have results back from the tests, so I still don't know what's going on.
Having said all that, here's the thing: I'm fine. Really, I am. That fact is as weird to me as it may be to some of you who have suffered from depression for years.
I don't feel sick, and, as far as I can tell, I'm not depressed. I'm happy. To tell you the truth, I feel great. I'm sleeping. I'm exercising (I swim a mile ever other day, and hope to push up the distance and the frequency soon). I don't feel as nervous. I pop a couple 100mg gapapentin caps if I want to make sure I get to sleep, but since I began swimming in earnest, I'm usually tired enough when I hit the hay to fall asleep without "medical assistance".
I've been off of selegiline for almost a month and a half now. Its antidepressant effects should have worn off a long time ago. Whatever is maintaining a euthymic state right now, it's not selegiline.
But don't think I've let my guard down. I'm pretty sure I am what psychiatrists call "atypical". I'm wondering quite seriously if I'm a bit like a trapeze artist working without a net at the moment: As long as I don't fall, I'm OK. But should I fall, things could get ugly. I don't want to end up in the hospital again.
As I survey my past, one thing is clear: I don't take rejection well. Granted, I've developed a considerably thicker skin over the years, but I'd need battleship armor to defend my emotions against the dreaded romantic breakup. Those kinds of things were what usually set me in a tailspin. The facts of my life right now are: I'm gainfully employed, financially independant, have a few good friends I can count on, and I'm in a good, stable relationship. The latter may be the key. I don't like looking at things in such a cynical way; after all, I certainly don't think I exploit relationships for the purpose of fighting depression, as I have the same basic desire for companionship that everyone else does. But for all practical purposes, I have to wonder if love is my antidepressant all the same. If this is true, I'm not sure if that's a good thing. It leaves me awfully vulnerable.
I guess right now I'm just wondering what the best course of action is: Get back on meds prophylactically, or stay off them and hope I don't tank. There's always the "kindling" theory of depression, too, that says things can build over time to a full-blown episode. That might mean, off of meds, that my days left before relapse are numbered, and it is a slow, downward spiral to that point.
It doesn't feel that way, though. Fear itself could be more of a problem than the potential risks that cause the fear. And, quite frankly, not being on selegiline hasn't been bad at all. I think those amphetamine metabolites were starting to take a real toll on me, especially the chronic insomnia. I just wasn't sleeping enough, and I have to wonder if my system was just exhausted. I have not had any severe "attacks" of the kind I described in the past for well over two weeks, despite doing some pretty strenuous exercise. I'm calmer, as I mentioned before. I don't seem to be as prone to obsession as I was. OCD-related problems were always that little itch I couldn't quite scratch on selegiline, and that seems to have relented to an extent.
What can I say: I feel good, but by no means did I know that I would at all. Is taking a go at a med-free life at all prudent given my history? To be honest, I just don't know.
Posted by Thrud on September 28, 2001, at 5:54:07
In reply to Not that I'm complaining, but..., posted by Adam on September 27, 2001, at 21:10:33
This a totally non-medical opinion...
Enjoy being medication free while you can. You will feel the warning signs when things are taking a turn for the worse. Unless you are prone to very sudden and strong episodes I would simply bask in the glory of being medication free until the clouds return.
I have not been able to bask in such glory for over 10 years and am very happy for you.Thrud
Posted by JohnL on September 29, 2001, at 7:31:14
In reply to Not that I'm complaining, but..., posted by Adam on September 27, 2001, at 21:10:33
Hi Adam,
I think that it's great you are remaining stable and well. I guess everyone might have a different opinion, but I think that as long as you are doing well without meds then fine. If you find yourself deteriorating in the future though, you will know it before it gets out of hand. You could then reconsider medication again. But as long as that is not the situation, just go on enjoying your days without any medication. I think that's great. Just my opinion though. You know the old saying "don't fix it if it aint broke". Or maybe, "don't rock the boat". :-)
John> A while ago, I quit selegiline cold turkey because I needed to get some tests for an as-of-yet undiagnosed medical condition. Well, I should qualify that: I don't agree with one doctor's diagnosis, at least at this juncture, and have been persistant about exploring the physiological rather than the psychological aspects of my symptoms. I still don't have results back from the tests, so I still don't know what's going on.
>
> Having said all that, here's the thing: I'm fine. Really, I am. That fact is as weird to me as it may be to some of you who have suffered from depression for years.
>
> I don't feel sick, and, as far as I can tell, I'm not depressed. I'm happy. To tell you the truth, I feel great. I'm sleeping. I'm exercising (I swim a mile ever other day, and hope to push up the distance and the frequency soon). I don't feel as nervous. I pop a couple 100mg gapapentin caps if I want to make sure I get to sleep, but since I began swimming in earnest, I'm usually tired enough when I hit the hay to fall asleep without "medical assistance".
>
> I've been off of selegiline for almost a month and a half now. Its antidepressant effects should have worn off a long time ago. Whatever is maintaining a euthymic state right now, it's not selegiline.
>
> But don't think I've let my guard down. I'm pretty sure I am what psychiatrists call "atypical". I'm wondering quite seriously if I'm a bit like a trapeze artist working without a net at the moment: As long as I don't fall, I'm OK. But should I fall, things could get ugly. I don't want to end up in the hospital again.
>
> As I survey my past, one thing is clear: I don't take rejection well. Granted, I've developed a considerably thicker skin over the years, but I'd need battleship armor to defend my emotions against the dreaded romantic breakup. Those kinds of things were what usually set me in a tailspin. The facts of my life right now are: I'm gainfully employed, financially independant, have a few good friends I can count on, and I'm in a good, stable relationship. The latter may be the key. I don't like looking at things in such a cynical way; after all, I certainly don't think I exploit relationships for the purpose of fighting depression, as I have the same basic desire for companionship that everyone else does. But for all practical purposes, I have to wonder if love is my antidepressant all the same. If this is true, I'm not sure if that's a good thing. It leaves me awfully vulnerable.
>
> I guess right now I'm just wondering what the best course of action is: Get back on meds prophylactically, or stay off them and hope I don't tank. There's always the "kindling" theory of depression, too, that says things can build over time to a full-blown episode. That might mean, off of meds, that my days left before relapse are numbered, and it is a slow, downward spiral to that point.
>
> It doesn't feel that way, though. Fear itself could be more of a problem than the potential risks that cause the fear. And, quite frankly, not being on selegiline hasn't been bad at all. I think those amphetamine metabolites were starting to take a real toll on me, especially the chronic insomnia. I just wasn't sleeping enough, and I have to wonder if my system was just exhausted. I have not had any severe "attacks" of the kind I described in the past for well over two weeks, despite doing some pretty strenuous exercise. I'm calmer, as I mentioned before. I don't seem to be as prone to obsession as I was. OCD-related problems were always that little itch I couldn't quite scratch on selegiline, and that seems to have relented to an extent.
>
> What can I say: I feel good, but by no means did I know that I would at all. Is taking a go at a med-free life at all prudent given my history? To be honest, I just don't know.
Posted by SLS on September 29, 2001, at 10:38:10
In reply to Not that I'm complaining, but..., posted by Adam on September 27, 2001, at 21:10:33
Hi Adam.
I do hope you remain well, whatever you decide to do.
> I've been off of selegiline for almost a month and a half now. Its antidepressant effects should have worn off a long time ago.
This is not necessarily so. The one time in my life that I felt almost normal (for more than a few days) was while I was taking a combination of Parnate + desipramine. After 6 months of normothymia, hypomania developed which, over the course of 2 months, became a severe dysphoric mania. Both drugs were discontinued and the mania was treated with lithium + clonazepam. After four weeks without the return of depression, I thought I was cured! By the end of eight weeks, depression reappeared.
Because of my case history of severity, chronicity, and treatment-resistance, it seems pretty clear that my doctor should have placed me back on an effective antidepressant regime after the mania had been controlled. Actually, I am not so sure it makes sense to withdraw antidepressants in this kind of scenario. I don't know that there is any data to support this course of action. Mood stabilizers or anti-manic drugs are to be administered anyway, so why not leave the antidepressants on-board?
> Whatever is maintaining a euthymic state right now, it's not selegiline.
It might be a sort of functional inertia. For those people who are to relapse after drug discontinuation, most will do so within four months. You are not out of the woods as far as this temporal window is concerned, so it's best to be wary of the signs that depression is reemerging. The key is to recapture the antidepressant response as soon as possible, or you risk becoming non-responsive to the previously effective drug.
Since you know plenty of my history, you'll know where I'm coming from when I say that were it me, I'd stay on selegiline (or some other therapeutic agent) indefinitely.
I wish you well. I never want to see you reappear on Psycho-Babble in search of a new drug. That way, you will continue to have nothing to complain about.
Good luck.
Sincerely,
Scott
Posted by Adam on October 2, 2001, at 17:18:24
In reply to Not that I'm complaining, but..., posted by Adam on September 27, 2001, at 21:10:33
Thanks for your input, all.
I guess I have identified some goals, into which the whole issue of drugs is wrapped:
1) Find a p-doc. I need somebody with experience, and who's residency isn't bound to end in a couple years. Call me picky, but I just think I'll have a better time with someone like that.
2) I have to find somebody who knows MAOIs, and isn't afraid to experiment a little. I would hope this person wont to collaborate with patients who are interested in trying different approaches, team effort.
3) Try to get info. on the status of the selegiline transdermal system, to see if it's worth it to wait out the approval period (new drug app. was filed last may).
4) Stick to neurontin in the mean time: It doesn't seem to be hurting me. I find it a bit hard to believe, but maybe it's helping with depression. Time will tell.
5) Try not to worry :-)
Posted by Noa on October 4, 2001, at 15:33:30
In reply to Re: Not that I'm complaining, but..., posted by Adam on October 2, 2001, at 17:18:24
Adam, I would think, too, that you are more perceptive now to any signals that depression is returning, so you could act early if it does.
It doesn't seem too surprising to me that a mood stabilizer could have AD effects.
Take care.
This is the end of the thread.
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