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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by SFY_Redux on July 15, 2018, at 11:02:42
Looking for some advice for my upcoming pdoc visit.
I have a history of Major Depressive Disorder, Social Anxiety Disorders and Anhedonia/Dysthymia as well as Early Morning Awakening Insomnia.
Had some success in the past with Prozac for the MDD, Nardil for the SAD, and Mirtazapine for the insomnia. Had to go off the Nardil because of very bad insomnia and the Mirtazapine no longer seems to do much (except cause unwanted weight gain). CBT has helped with the SAD as well but I seem to hit a plateau that I cant get beyond.
Im currently struggling with recurrent mild depression (flat affect, amotivation, depressed mood), a flare-up of my SAD (which never really goes away), and the reemergence of my early morning awakening insomnia. There also seems to be some diurnal variation in my depression as I feel much worse in the morning which is exacerbated by the insomnia.
Right now, weve been trying to manage the insomnia to no great effect - doxepin, temazepam, melatonin with no improvement. Due to another condition, I need to avoid anything that acts as a strong antihistamine effect.
With the more recent flare ups in my depression, I think we need to revisit antidepressant treatments with something that may impact the insomnia. Bupropion and Trintellix (which I didnt react well to) have both been tried.
Right now, Im stuck in the weeds looking at meds and wondering if anyone had some thoughts that might be helpful.
Posted by rjlockhart37 on July 15, 2018, at 16:32:19
In reply to Advice Needed - Depression/Anxiety Treatment, posted by SFY_Redux on July 15, 2018, at 11:02:42
you could try Prozac at maximum, or 60-80mg for depression, but if you already tried it, there's this stuff called Rozerem, its not really considered a 'successful' drug, but it effects melatonin receptors, another option is Belsomra which is new medication. That shuts off awake states. Last option which probably won't really be considered, but there's a medication called 'Prosom' (estazolam) it's a benzo that's a long term acting for insomnia, it lasts a while, but i'm not so sure if doctor would be in favor of that. It's not so popular today anymore.
Those are the only thing could think
Posted by rjlockhart37 on July 15, 2018, at 16:36:33
In reply to Re: Advice Needed - Depression/Anxiety Treatment, posted by rjlockhart37 on July 15, 2018, at 16:32:19
rozerem, belsomra, prosom are insomnia medications not depression, i should of seperated that....
Posted by SFY_Redux on July 16, 2018, at 9:10:45
In reply to Re: Advice Needed - Depression/Anxiety Treatment, posted by rjlockhart37 on July 15, 2018, at 16:32:19
> you could try Prozac at maximum, or 60-80mg for depression, but if you already tried it, there's this stuff called Rozerem, its not really considered a 'successful' drug, but it effects melatonin receptors, another option is Belsomra which is new medication. That shuts off awake states. Last option which probably won't really be considered, but there's a medication called 'Prosom' (estazolam) it's a benzo that's a long term acting for insomnia, it lasts a while, but i'm not so sure if doctor would be in favor of that. It's not so popular today anymore.
>
> Those are the only thing could thinkThanks for that.
When I was on Prozac (up to 40 mg.), it led to insomnia requiring the addition of Trazodone to my regimen so I dont think Ill go that route.
Tried Rozerem a few years ago but it didnt seem to have any effect. Havent had any experience with Belsomra but Ill definitely look into it.
Posted by Christ_empowered on July 16, 2018, at 11:45:32
In reply to Advice Needed - Depression/Anxiety Treatment, posted by SFY_Redux on July 15, 2018, at 11:02:42
hi. have ever tried a stimulant? ritalin or focalin are still used in depression. amphetamines are, too, but...id try the ritalin or focalin 1st, if those are options. there's also provigil, nuvigil...but those tend to be very expensive, so insurance coverage could be an issue.
now and then, other stimulants are used in psych indications. tenuate...chemically, its like super wellbutrin. its licensed as a diet pill.
mirapex...im considering asking my shrink about this for depression or 'negative symptoms' (my diagnosis varies from 'expert' to 'expert' so...there you go...). some people report good results.
the other stuff...high dose effexor, possibly with buspar (buspirone can help boost antidepressants...), "alternative" stuff as an...well...alternative (not intentional, lol), or to improve results from standard treatments...
wellbutrin goes well with ssri drugs, for some people. lexapro+wellbutrin, for instance. if you go that route, id suggest a more calming/mellowing ssri (probably not prozac, unless you really like prozac) and then the wellbutrin. i just suggested maybe a stimulant because they work fast and drug-drug interactions w/ wellbutrin can get tricksy, and...nobody wants seizures, right?
ok. hope this helps. sorry you're going thru it.
Posted by bleauberry on July 19, 2018, at 9:15:50
In reply to Advice Needed - Depression/Anxiety Treatment, posted by SFY_Redux on July 15, 2018, at 11:02:42
You seem to be engaged and educated on meds. I can't really offer any suggestions there. Maybe a couple points.
Try Ritalin all by itself. Really! Look I could go on a long spree here and explain in lengthy detail why I say that. Long story short - it all boils down to whether your dopamine receptors are currently unregulated or down regulated. Keep in mind, school children become CALM and peaceful on stimulants. I, for one, had the best sleep of my life on the stimulant Ritalin! And according to some clinical studies, especially for the elderly, and according to my own experiences, it is usually better than any of the antidepressants at improving depression.
I would suggest getting a book called Healing Lyme by Stephen Buhner and read it thoroughly. I'm not suggesting you have undiagnosed unsuspected lyme, though your story and symptoms are 100% consistent with that, and I'm not suggesting herbs instead of meds. But I am strongly suggesting that if you read this book you will find your way to remission much faster than if you stay on the road you are currently on.
In my world, where I came back from 20 years of treatment resistant depression which even failed ECT, these are the causes of depression not related to a life event: 1.Unsuspected stealth chronic infections, such as Lyme or Lyme-like (dozens) 2.Environmental toxicity (amalgams, mercury, lead, aluminum, cadmium, plastics, herbicides, pesticides, gluten, and genetically modified grains) 3.Systemic inflammation and/or brain inflammation. 4.Immune system imbalance.
The book show you how to address all of those simultaneously with over the counter inexpensive safe botanical medicines, herbs and common supplements. Sometimes we make a big huge deal out of it all and go to the highest powered psychiatrists we can find and take the heaviest duty cocktails we can make, when in fact all of that may be unnecessary and ineffective.
What I am saying is do the best you can with med choices but do it with a short-term goal in mind - the meds are most appropriate for acute symptoms but not so helpful in chronic conditions. That's where the other strategies outside of meds come into play. It's like an orchestra. You will get a much better song, much richer sound, with an entire orchestra rather than a single solo player.
Calming herbs that work as good as Xanax except without addiction are combinations of Lemon Balm, American Skullcap, Passionflower, and Valerian root.
In your case I think major improvement can come from the 'adaptogen' herbs - rhodiola rosea, ashwagandha, eleuthero, and others. Hard to explain. They are sort of like agonists and antagonists at the same time, so they tend to balance out in the body whatever is out of balance. Very helpful for issues involving energy, motivation, endurance, engagement, and mood. If you think about it, for example, an insomnia situation is basically too much adrenaline. That's where adaptogens come in to balance that out.
Anyway, just thinking out loud.
> Looking for some advice for my upcoming pdoc visit.
>
> I have a history of Major Depressive Disorder, Social Anxiety Disorders and Anhedonia/Dysthymia as well as Early Morning Awakening Insomnia.
>
> Had some success in the past with Prozac for the MDD, Nardil for the SAD, and Mirtazapine for the insomnia. Had to go off the Nardil because of very bad insomnia and the Mirtazapine no longer seems to do much (except cause unwanted weight gain). CBT has helped with the SAD as well but I seem to hit a plateau that I cant get beyond.
>
> Im currently struggling with recurrent mild depression (flat affect, amotivation, depressed mood), a flare-up of my SAD (which never really goes away), and the reemergence of my early morning awakening insomnia. There also seems to be some diurnal variation in my depression as I feel much worse in the morning which is exacerbated by the insomnia.
>
> Right now, weve been trying to manage the insomnia to no great effect - doxepin, temazepam, melatonin with no improvement. Due to another condition, I need to avoid anything that acts as a strong antihistamine effect.
>
> With the more recent flare ups in my depression, I think we need to revisit antidepressant treatments with something that may impact the insomnia. Bupropion and Trintellix (which I didnt react well to) have both been tried.
>
> Right now, Im stuck in the weeds looking at meds and wondering if anyone had some thoughts that might be helpful.
Posted by meltingpot on July 20, 2018, at 10:08:56
In reply to Advice Needed - Depression/Anxiety Treatment, posted by SFY_Redux on July 15, 2018, at 11:02:42
Hi,
Have you tried 10mg of Zyprexa (Olanzapine)? I've found when I'm really bad, anxious, can't sleep, suicidal etc, Zyprexa knocks me out completely and I actually wake up feeling better after having taken it.
Once I slept two days solid on it.
Denise
Posted by SFY_Redux on July 20, 2018, at 15:31:46
In reply to Zyprexa, posted by meltingpot on July 20, 2018, at 10:08:56
> Hi,
>
> Have you tried 10mg of Zyprexa (Olanzapine)? I've found when I'm really bad, anxious, can't sleep, suicidal etc, Zyprexa knocks me out completely and I actually wake up feeling better after having taken it.
>
> Once I slept two days solid on it.
>
>
> DeniseThat sounds like it would be too overwhelming for me. I sleep but wake up 2 or 3 hours early without being able to fall back asleep. (And theres little to no apparent anxious/depressed thought pattern to cause the early awakening.)
Posted by Christ_empowered on July 20, 2018, at 17:51:50
In reply to Re: Zyprexa, posted by SFY_Redux on July 20, 2018, at 15:31:46
hi. tranquilizers/neuroleptics can be helpful on a prn basis. im not a big fan of zyprexa, just because of the metabolic stuff, plus it gave me bad akathisia.
maybe a sedative and a tranquilizer? like...ativan+perphenazine, gabapentin (or lyrica)+a bit of risperidone? I dunno. especially when using just on an as-needed basis, adding in a sedative can mean a lower dose of the tranquilizer, which=less dysphoria, cognitive issues, eps, akathisia, etc.
I would imagine that as-needed neuroleptics would need to be more moderate to high potency. low potency agents (thorazine, seroquel) would be intensely sedating, and dysphoria is still a potential issue.
a former poster here uses/used abilfy, as needed. I seem to to recall a benzodiazepine in the mix, also. abilify is now generic, thank goodness.
Posted by meltingpot on July 28, 2018, at 12:36:54
In reply to Advice Needed - Depression/Anxiety Treatment, posted by SFY_Redux on July 15, 2018, at 11:02:42
Hi,
You could maybe try Lyrica, I have found it helps with sleep and helps my mood.
Denise
This is the end of the thread.
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