![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by fido on March 2, 2015, at 17:03:14
I read a book by a swiss psychiatrist who treats hard cases and this person basically says that people who have been depressed for a long time or who relapse during antidepressant therapy need to also be put on lithium or another mood stabilizer.
I never heard this before. She even wrote that she would prefer lithium over an antidepressant as long term protective measure.
But lithium seems pretty scary to me because you have to measure the levels all the time and from what I read it can also have many side effects.
I really don't think that I'd even dare to take it.
But then again I think what if lithium would work?
She wrote that lithium usually starts to work already within days. If this is so then you could quickly find out if it helps and if not get rid of it again.Another option would be lamictal. But I also dont know much about it. My pdoc didnt really want to put me on it cause he said it has more side effects than antidepressants. I also dont even know if my insurance would cover the costs cause I'm not bipolar and lamictal isn't officially allowed for normal depression, at least where I live.
What do you think about this? I mean if antidepressants don't work then sooner or later you have to try something else. But at the same time moving to other classes of drugs is also harder for me cause it's more scary. For example I'd not want to try an AAP because of the EPS risk and also because of the class. It's like once you start to take an antipsychotic it's as if you're officially "psychotic" and no longer only depressed. I dont want to go down that road.
Posted by Escapee on March 2, 2015, at 17:20:33
In reply to Lithium or lamictal in unipolar depression?, posted by fido on March 2, 2015, at 17:03:14
Hi fido. Trust your doctor. I am going on lithium soon for unipolar depression. I currently take trimipramine, bupropion and isocarboxazid, plus quetiapine and clonazepam. I am currently waiting for blood tests before my pdoc adds lithium to the combo.
I have tried lamotrigine and soon lithium. When asked how lithium works against depression he admitted "we dont quite understand why it lifts mood. But all we know is that in some people it does. Works very well too.
Posted by Christ_empowered on March 2, 2015, at 19:11:51
In reply to Re: Lithium or lamictal in unipolar depression? » fido, posted by Escapee on March 2, 2015, at 17:20:33
Personally, I'd try Lamictal first, then lithium if needed, then an AAP. Just my suggestion.
Posted by PeterMartin on March 2, 2015, at 19:53:24
In reply to Re: Lithium or lamictal in unipolar depression?, posted by Christ_empowered on March 2, 2015, at 19:11:51
Lamictal was always a much better antidepressant for me than the commonly prescribed SSRIs. The side effects are also much less annoying so long as you don't get "the rash". Never had sexual side effects or weight issues w Lamictal. It does take a month or so to titrate up though.
Lithium can definitely help too but due to the side effects/etc I agree that Lamictal would be the one to push for. Ive been on it longer than anything else (8yrs now).
Good luck.
Posted by Phillipa on March 2, 2015, at 20:28:50
In reply to Lithium or lamictal in unipolar depression?, posted by fido on March 2, 2015, at 17:03:14
Since lithium can effect the thyroid gland discuss this with your doctor. Phillipa
Posted by baseball55 on March 2, 2015, at 21:22:07
In reply to Re: Lithium or lamictal in unipolar depression? » fido, posted by Phillipa on March 2, 2015, at 20:28:50
Both lithium and lamictal are effective in controlling suicidal urges. Lamictal takes time to use - you need to ramp up the dose over a few weeks before reaching a therapeutic dose in order to minimize the risk of Stephens-Johnson syndrome. My experience with lamictal is that it has no side effects at all, but others on this list have had different experiences.
Lithium is highly effective for suicidal ideation. The doses needed for this purpose are low, so no need to do blood levels or regular monitoring of kidney function, etc. I have found it highly effective for this symptom - more so than lamictal - and, like lamictal, without side effects.
However, I did not find either drug effective against other depressive symptoms. The only drugs that lifted the worst depressive symptoms for me were parnate (MAOI) and abilify. Abilify was like magic for me and is for many people with depression. EPS is rare. However, metabolic problems are not.
MAOIs are very effective treatments for severe depression. Generally have many noticeable side effects, but for treatment resistant depression, the benefits can far outweigh the costs.
Posted by fido on March 3, 2015, at 21:08:25
In reply to Re: Lithium or lamictal in unipolar depression?, posted by baseball55 on March 2, 2015, at 21:22:07
Thanks for your replies.
I am also definitely leaning towards lamictal. Lithium is too intimidating. I also have hashimoto and I dont want to mess with my thyroid.How much lamictal would you need minimum in order to get an effect? And how hard is it to tell wether it does something?
The problem is that I dont feel equally depressed all the time. It depends very much on the situation. I may have days or weeks where I feel 5/10 and then I have days where I feel 1/10. This makes it much harder to even tell if a drug works or not cause how shall I know if I would have felt the same way without a drug? Basically I can only tell that a drug doesn't work when I experience really bad days cause then I know that it doesn't seem to work.
And can you start really low by splitting tablets? That would be important for me. I always start really low when I go on a new drug.And would you say that lamictal is worth going on even without having a working antidepressant in the first place? At the moment I basically have nothing. I quit cymbalta cause it didn't work and now I don't really know what to try next. If lamictal worked and didn't have side effects then I could get it on board and then keep looking for an antidepressants.
Posted by baseball55 on March 4, 2015, at 19:05:35
In reply to Re: Lithium or lamictal in unipolar depression?, posted by fido on March 3, 2015, at 21:08:25
I used lamictal without an AD, but my depression at the time was under control. I just had severe mood swings and constant problems with suicidal ideation. I don't know how lamictal by itself works for depression. Though, from what you wrote, it seems that your issue is mood fluctuations more than conventional depression. Lamictal is good for stabilizing moods.
As far as dose - lamictal is always titrated slowly and you should not ramp up the dose on your own. This is because lamictal, very rarely, can cause a life-threatening skin condition called Stephens-Johnson syndrome. So you would ramp up to the therapeutic dose - usually 200mg - over 2-3 weeks.
Posted by burial on March 5, 2015, at 6:25:56
In reply to Re: Lithium or lamictal in unipolar depression? » fido, posted by baseball55 on March 4, 2015, at 19:05:35
I recently restarted lamictal and it blasted out the depression within a week.
Posted by porkpiehat on March 5, 2015, at 9:11:24
In reply to Re: Lithium or lamictal in unipolar depression? » fido, posted by baseball55 on March 4, 2015, at 19:05:35
I've taken Lamictal with Celexa for 10 years now. It was initially to curb some of the manic/compulsive behaviors I was having on the SSRI but it touched on some depressive symptoms such as motivation and self promotion and social anxiety like AD's hadn't.
During switches to other (or no) AD Lamictal seemed to act differently, almost sedating, whereas with Celexa sometimes it makes me racy and It's hard to read/concentrate at higher doses.
FOR ME and some others who have posted it is VERY difficult to come off Lamictal if you've been on it for a while. If I go down to 150mgs I'm flat out suicidal.
Posted by B2chica on March 6, 2015, at 14:13:28
In reply to Re: Lithium or lamictal in unipolar depression?, posted by burial on March 5, 2015, at 6:25:56
when this happened what dose were you on? how quickly did you titrate up?
-b2
Posted by fido on March 6, 2015, at 18:20:08
In reply to Re: Lithium or lamictal in unipolar depression?, posted by B2chica on March 6, 2015, at 14:13:28
What pork wrote is damn scary!
I dont want to get on something and then depend on it. :(
I can't really tell if I have "mood swings". I definitely dont have mania. I would say that I have double depression. I'm constantly in a state where I'm pessimistic and melancholic and then when the circumstances also get bad my depression gets a lot worse.
For exmaple I have many health issues which depress me. But every time I am reminded of them for example if a symptom gets worse or if I discover something on my body which scares me then I become depressed immediately. I cant defend myself against this. It knocks me off my feet and then I'm basically unable to focus on other things which I needed to do. This is especially problematic in times where I needed to function and where I cant afford being depressed and lying in bed.
For me it's simply too much to deal with. Other people who are sick may be able to accept it but I cant. Every time a symptom shows up or gets worse than it was before I feel terrible.I mean what shall I take against this? I dont think that there is any antidepressant out there which is strong enough to prevent this. I was already depressed when I had no personal problems years ago and now I have all kinds of problems which give me plenty of reason to be depressed.
Posted by baseball55 on March 6, 2015, at 19:23:33
In reply to Re: Lithium or lamictal in unipolar depression?, posted by fido on March 6, 2015, at 18:20:08
> I mean what shall I take against this? I dont think that there is any antidepressant out there which is strong enough to prevent this. I was already depressed when I had no personal problems years ago and now I have all kinds of problems which give me plenty of reason to be depressed.
>
I don't mean to sound facile, but if you are depressed because of real problems which "give you something to be depressed about," then I'm not sure I would really call this depression. Or maybe would call it "situational depression." The issue is that medication isn't going to change how you feel, except maybe marginally, because medication isn't going to change the situation.Generally, with situational depression, the recommendation is to work with a therapist - not some sort of nebulous, examining your life kind of therapy, but something like DBT or CBT where you work on controlling and modifying your reactions to sources of distress.
It can help to learn to alter your response to - legitimate - distress about serious issues in your life. Becoming despairing or railing against misfortune can increase your suffering. Many of these sorts of therapeutic modalities are not dissimilar to some religious or spiritual practices.
Posted by Phillipa on March 6, 2015, at 19:58:01
In reply to Re: Lithium or lamictal in unipolar depression? » fido, posted by baseball55 on March 6, 2015, at 19:23:33
To me this is fear. Fear of illnesses getting worse or a new one starting. As we age this becomes more of a problem. I am the same. And no therapist can stop medical problems or solve them or keep age at bay
Posted by Escapee on March 7, 2015, at 12:45:59
In reply to Re: Lithium or lamictal in unipolar depression? » baseball55, posted by Phillipa on March 6, 2015, at 19:58:01
No therapist perhapse, but some drugs and micro-nutrients have been proven to reverse the ageing process. Esp of the mind.
Posted by Escapee on March 7, 2015, at 13:07:19
In reply to Re: Lithium or lamictal in unipolar depression? » fido, posted by baseball55 on March 6, 2015, at 19:23:33
> > I mean what shall I take against this? I dont think that there is any antidepressant out there which is strong enough to prevent this. I was already depressed when I had no personal problems years ago and now I have all kinds of problems which give me plenty of reason to be depressed.
> >
> I don't mean to sound facile, but if you are depressed because of real problems which "give you something to be depressed about," then I'm not sure I would really call this depression. Or maybe would call it "situational depression." The issue is that medication isn't going to change how you feel, except maybe marginally, because medication isn't going to change the situation.
>
> Generally, with situational depression, the recommendation is to work with a therapist - not some sort of nebulous, examining your life kind of therapy, but something like DBT or CBT where you work on controlling and modifying your reactions to sources of distress.
>
> It can help to learn to alter your response to - legitimate - distress about serious issues in your life. Becoming despairing or railing against misfortune can increase your suffering. Many of these sorts of therapeutic modalities are not dissimilar to some religious or spiritual practices.
>Dont believe what I just read. ANYTHING can cause depression! So you do not think child abuse can cause depression in adulthood? Sexual abuse/rape? Bullying? Jail? Homelessness? Junkies for parents who can only afford there gear, hence creating major nutrient deficiencies in both themselves and esp their child that can cause life long brain damage requiring life long medication? Losing a loved one?
None of these deserve the use of antidepressants? They never help to heal?
And how can you call it depression if nobody knows the cause?
Its ALL depression. Sadly.
Of course some lucky people can make it with just talking therapies, counselling through to psychotherapy. Chats with a group, be it Church or AA. Tho I know that over half the people around here that attend AA & NA also have serious 'mood' disorders which they must continue to take.
Posted by Phillipa on March 7, 2015, at 19:12:25
In reply to Get Real! » Phillipa, posted by Escapee on March 7, 2015, at 12:45:59
Got a link? As from what I know and have read not the case
Posted by Phillipa on March 7, 2015, at 19:18:53
In reply to Re: Get Real! » Escapee, posted by Phillipa on March 7, 2015, at 19:12:25
Can psych meds heal or make better MS, Cancer, Heart Disease, other illnesses that are not psychological but health problem. Diseases of the body?
Posted by Escapee on March 11, 2015, at 8:05:20
In reply to Re: Get Real! » Escapee, posted by Phillipa on March 7, 2015, at 19:12:25
> Got a link? As from what I know and have read not the case
No link. Just layman's knowledge.
Posted by Escapee on March 11, 2015, at 8:52:33
In reply to Re: Get Real!, posted by Phillipa on March 7, 2015, at 19:18:53
> Can psych meds heal or make better MS, Cancer, Heart Disease, other illnesses that are not psychological but health problem. Diseases of the body?
The brain is a physical organ. Without it NOTHING would work. Receives messages from the senses and uses them to make the next appropriate movement or other bodily functions. Hayfever is a classic example. Pollen gets in the blood and the brain responds by sending a message back to your mucus glands (?) too make them produce (as most call it) snot to clear the nose of pollen.
Cancer? Many have claimed that meditation and certan 'visualising' techniques plays a big part in the healing process too. Same with psoriasis sufferers, an autoimmune illness (I do not like using the word 'disease'). I think most would agree that a cancer patient with a positive attitude would stand far more chance of recovery than a pessimistic or depressed patient.
Personally I have type 1 diabetes. Stress almost always alters my blood glucose levels. To me, the thought of the brain-mind being seperate from the physical body is ludicrous.
Finally amitryptyline, a common TCA also works for, among other physical manifestations helps many types of pain, headaches, diabetic neuropathy and even bed wetting in children.
Escapee.
Posted by Phillipa on March 11, 2015, at 9:18:23
In reply to Re: Get Real! » Phillipa, posted by Escapee on March 11, 2015, at 8:52:33
Does the mind cause osteoporosis, osteo arthritis, bone spurs, spinal stenosis, cause people as they age to require the use of glasses to read? What about thyroid as have this, and lymes disease which is called disease. Also loss of sense of taste and smell. Which without memories can not be recovered as smell is responsible for recalling smells of the past? One can try to treat some symptoms of some illnesses but not all. see neighbors die of heart attacks about weekly around here or cancers they have been fighting with medications and counselling for years but the ultimate outcome is the disease overcomes the body. That's my take.
Posted by Escapee on March 11, 2015, at 21:11:42
In reply to Re: Get Real! » Escapee, posted by Phillipa on March 11, 2015, at 9:18:23
Im quite confident that the word 'disease' probably derived from 'dis-ease. (Uneasy, not at ease, unable to be at ease). I consider all of the illnesses you mention are far far away from fitting the description of 'uneasy'. I would not be very amused either with anyone referring to my diabetes as a DISEASE would you?
Illness means what is says. ANY part of your entire being that is unwell, its ill. Sick. Any severity can use the same word. Mild illness (more of a nuisance really). Hayfever, dandruff, blisters, cuts and bruises. Next up could be any broken bones, diabetes (which is often extremely well controlled), eczema and psoriasis, food and chemical intollerences, moderate depression and anxiety needing medication. Finally severe illnesses like cancer, heart disease, TRD or any kind of depression that involves suicidal ideation, bipolar, schizophrenia, alzimers, parkinsonism, blindnes or an loss of many senses, lack of limbs or amputations.
Sorry thumb has a mind of it own.
Posted by Phillipa on March 11, 2015, at 21:48:15
In reply to Re: Get Real! » Phillipa, posted by Escapee on March 11, 2015, at 21:11:42
Posted by Phillipa on March 11, 2015, at 21:50:04
In reply to Re: Take your pick » Escapee, posted by Phillipa on March 11, 2015, at 21:48:15
http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm
Posted by Escapee on March 12, 2015, at 5:32:36
In reply to Re: Take your pick » Escapee, posted by Phillipa on March 11, 2015, at 21:48:15
> http://en.wikipedia.org/wiki/Disease All I could call that link is 'theory'.
Im unsubscribing from this link its a waste of time. Not something I want to babble on about any more.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.