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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by mommyron on June 4, 2010, at 19:59:39
I'm seeing my doc next week, he is very receptive to taking my lead when that's what I want. I feel hopeless though, as to options. I've posted here a lot and you've given me some good feedback, but I've been too afraid to run with it. I've been on gobs of SSRI's...Prozac worked a bit but not the others. Effexor and Cymbalta worked better but bad side effects. Emsam worked well but the rash forced me to stop. I have had depression since childhood, some borderline issues and mild bipolar (no highs, per se, but sometimes rapid cycling between "doing okay" and "hell"). I'm depressed, having a hard time in my marriage, have a 10-year-old with a history of cancer, and I have to pull myself together. Some of you are so experienced and I would really appreciate any suggestions for what you think might be a good med(s) to try. Especially Bleuberry. I'm currently on 100 mg Seroquel and that's all I'm taking. Thank you so much, Teresa
Posted by linkadge on June 4, 2010, at 20:33:03
In reply to need advice from others (incl bleuberry), posted by mommyron on June 4, 2010, at 19:59:39
If emsam worked, perhaps a trial of a conventional (nardil / parnate) MAOI would be warrented. Wellbutrin or nortriptyline / desipramine might be worth a shot.
Linkadge
Posted by Phillipa on June 4, 2010, at 21:28:09
In reply to Re: need advice from others (incl bleuberry), posted by linkadge on June 4, 2010, at 20:33:03
So sorry about your child how stressful that must be. I defer to the experts. Just wanted to welcome you back. Phillipa
Posted by mommyron on June 4, 2010, at 21:33:42
In reply to Re: need advice from others (incl bleuberry), posted by linkadge on June 4, 2010, at 20:33:03
Thanks Philippa. Linkadge--I have a lot of anxiety (a new feature), and thought nardil/parnate might worsen it. Desipramine was not good for me, it did not alleviate depression and made me into a zombie. Wellbutrin did not work and gave me the shakes. Can you tell me about nortryptaline?
Posted by Phillipa on June 4, 2010, at 21:58:54
In reply to Philippa + Linkadge, posted by mommyron on June 4, 2010, at 21:33:42
I'm confident Link can. Phillipa
Posted by bleauberry on June 5, 2010, at 6:17:14
In reply to need advice from others (incl bleuberry), posted by mommyron on June 4, 2010, at 19:59:39
The title of your post says you need advice. Well, I'm not qualified to give advice. But I can at least think out loud, and maybe somewhere in those thoughts you might find something helpful? Maybe, maybe not, but here goes.
Of the ssris, only Prozac was somewhat helpful and tolerable at the same time. But it wasn't complete, and there is the issue of mood swings. So immediately Zyprexa came to mind. The combination of the two works much better on depression than either alone, and simultaneously smooths out the swings. The combo dramatically increases norepinephrine and dopamine in the mood centers of the brain, which is what Ensam did, but by a different mechanism. If weight gain is an issue, the price you'll have to pay is closer attention to what you put in your grocery cart. Which is in my book, regardless, the number one place to start when treating any chronic illness.
Since Ensam did work, immediately Nardil and Parnate came to mind. Both can be very good for anxiety as well, though I think Nardil is better known for that.
If desipramine made you a zombie, nortriptyline might as well. Maybe not.
I guess the seroquel is probably better than nothing. But if there was any single antipsychotic to take for maintenance, my top choice is zyprexa.
If you are into trying meds from other countries, the antipsychotic/antidepressant Amisulpride could be a good choice. We Americans sometimes display an arrogant syndrome called NIH. That is, Not Invented Here. Some of the meds from around the world have mechanisms unlike anything we have in the US, they have long respectable track records, hundreds of clinical studies, approved and used in many countries, and can be very useful when we run out of options with the limitations the FDA gives us. Amisulpride is a top choice in that category for the symptoms you described. Depression, dysthymia, anhedonia, anxiety, mood swings, it covers the whole spectrum and does so at such low doses there are hardly any side effects.
Since Cymbalta was helpful but the side effects were too strong, there is the possibility of taking it again except at a lower more tolerable dose and then adding another antidepressant to it. I know it sounds weird and would be kind of unorthodox, and some risk if not monitored carefully in the early days, but something like a low dose prozac plus low dose effexor or low dose cymbalta might be considered.
Prozac plus Ritalin? Maybe a tad bit of seroquel or zyprexa along with it to offset any overstimulation if it happened.
It's a tough game. I wish there was an easier way. But hopefully you'll get some ideas. If it were me in your shoes, all of the above would be on my to-do list. The hard part is deciding where to start, what to do first.
Posted by mommyron on June 5, 2010, at 10:55:36
In reply to Re: need advice from others (incl bleuberry), posted by bleauberry on June 5, 2010, at 6:17:14
Bleuberry, I like your comment about the importance of diet when dealing with any chronic illness. It's particularly frustrating to me, as I am impeccable with my diet, and am a hollistic nutrition student at the moment. I wish I could cover my depression nutritionally--I can make inroads that way but whatever imbalance I have seems to require more. Tell me--do you know how you can get Amisulpride, if it's not FDA-approved? Can my doctor prescribe it at all? Thank you for brainstorming with me. Warmly, Teresa
Posted by Christ_empowered on June 5, 2010, at 12:57:23
In reply to Re: need advice from others (incl bleuberry), posted by bleauberry on June 5, 2010, at 6:17:14
hey...sorry about your situation :-(
I'm kind of struck by how within the box your treatment has been. No benzos, no stimulants, no combos. I'm not saying that's bad, I'm just saying don't give up yet--there are options.
Bleauberry mentioned zyprexa, and I think that could be good..in *small* doses, possibly even as an "as-needed" med at bedtime. Zyprexa is notorious for weight gain; I've heard that using metformin along with it tends to keep that to a minimum (the weight gain can happen even w/o changes in your diet. According to my ex-shrink, you can even get diabetes from zyprexa w/o weight gain. Be careful).
B. also mentioned Ritalin. These days, with the high failure rates of the Antidepressants gaining more attention, more docs are going the old school route and adding stimulants. Ritalin was marketed as a "psychic energizer" back in the day. Chemically, its a lot like cocaine. Amphetamines (adderall, dexedrine, vynase, perhaps even desoxyn) can be used for depression, too; I would think these would be great for someone with anhedonia (adderall treated my depression like nothing else would), but there are risks.
I would recommend you try niacinamide, if you haven't already. Some docs used it alot for anxiety and schizophrenia back in the day; higher doses (like those used in schizophrenia) seem to have antioxidant properties that can help protect you from drug-induced tardive dyskinesia. From my own experience, I found that 4 grams daily (I did 2 doses; some do higher doses in 3 doses) helped me get a lot more mileage out of Klonopin and made the taper easier. Even on its own it helped even me out; supposedly, niacinamide is a sort of natural tranquilizer. It may also help the skin.
Have you tried Lamictal? Its not the greatest thing ever, and there are side-effects, but it tends to stabilize mood pretty well for people with BP II or severe, treatment-resistant depression.
I wish you well. :-)
Posted by linkadge on June 5, 2010, at 14:42:47
In reply to Philippa + Linkadge, posted by mommyron on June 4, 2010, at 21:33:42
nortriptyline is a good antidepressant. It can still work if desipramine fails. Nardil might be a better choice than parnate. Parnate is more stimulating, but nardil tends to be better for anxiety (it has a metabolite that potently increases the activity of gaba).
Linkadge
Posted by mommyron on June 5, 2010, at 16:06:37
In reply to Re: need advice from others (incl bleuberry), posted by Christ_empowered on June 5, 2010, at 12:57:23
to Christ-empowered: I've tried Lamictal and it was quite helpful. It made my hair fall out though. I was combo-ing Lamictal, Seroquel and Lexapro for quite a while. I shy away from Zyprexa, after what you say, as I had metabolic syndrome and was headed for diabetes. Lost a lot of weight and worked hard on my diet...and lowered Seroquel (which can also cause blood sugar issues) from 300 to 100 mg. This is overwhelming... Thank you so much, Teresa
Posted by desolationrower on June 6, 2010, at 2:17:34
In reply to Re: need advice from others (incl bleuberry), posted by mommyron on June 5, 2010, at 16:06:37
well i might try notriptaline and then phenlezine.
the first is less likely to work, but eh latter will likely cause 10-15lbs gain.
why lamactil did you stop, the hair?
have you been on lithium before? do you try NAC
-d/r
Posted by linkadge on June 6, 2010, at 12:17:49
In reply to Re: need advice from others (incl bleuberry), posted by desolationrower on June 6, 2010, at 2:17:34
I don't think there is any evidence that the MAOIs are more likely to work than a TCA's.
I think what the evidence shows is that when MAOI's do work for a patient, they tend to work extremely well.
The TCA's are more effective for certain subgroups of depression.
Posted by desolationrower on June 6, 2010, at 13:59:11
In reply to Re: need advice from others (incl bleuberry), posted by linkadge on June 6, 2010, at 12:17:49
> I don't think there is any evidence that the MAOIs are more likely to work than a TCA's.
>
> I think what the evidence shows is that when MAOI's do work for a patient, they tend to work extremely well.
>
> The TCA's are more effective for certain subgroups of depression.
>
>well she had tried w/o benefit desipramine, and wasn't contemplating a kitchen sink TCA which are more effective but also more side effects
-d/r
Posted by mommyron on June 6, 2010, at 20:57:04
In reply to Re: need advice from others (incl bleuberry), posted by bleauberry on June 5, 2010, at 6:17:14
My doc is leaning towards Parnate or Nardil. How does one get Amisulpride? and how does one get a doctor that can monitor it??? (Bleuberry I am fascinated with your knowledge and curious about your background...) I'm leaving for Israel on June 15, and will be there a couple of weeks, so I COULD get the Amisulpride there I suppose. I am awed by the wealth of information this group of people has...
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