Posted by SLS on March 14, 2001, at 22:44:38
In reply to Re: treatment resistant depression - Scott » SLS, posted by sweetmarie on March 14, 2001, at 12:21:28
Hi Anna.
> I`m glad to have been of some use. Like you, I can`t afford to rule anything out (if that`s what you were saying).Yup. That's the story.
> I`ve been very severely depressed for about 3 years, with all the stuff that goes with that (inability to work, have a social life, carry on any meaningful relationships with friends, etc.)
Yup. I know this story too. I am sorry that you had to tell it.
> Nobody in my family has ever been diagnosed with Bipolar Disorder, and it has certainly never been suggested to me that I may have it.
The reason I asked is because you having been taking two "mood-stabilizers", Lamictal (lamotrigine) and Epilim (valproate). This is a strategy that is generally associated with bipolar disorder rather than unipolar major depression. I am very interested to know how critical a role both play in getting you well.
> The only other person I know of who suffers at all from depression is my sister, who gets mild depression for short periods, and are adequately treated with a short course of anti-depressants. Her low moods are `reactive` though, unlike my illness which is genetically based,
Just for the sake of extending understanding, and not as an attempt at diagnosis, all of the features you described above can be symptoms of a "soft" bipolar presentation. My sister has followed exactly the same scenario, her bipolarity being evidenced by a hypomania induced by Nardil, an MAO-inhibitor antidepressant. Bipolar disorders are extremely heritable (genetic) and very often appear among siblings, although not necessarily to the same degree.
> 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.
> She has a very stressful job - she`s a psychiatric nurse (enough said, probably).
Again, for the sake of understanding, stress can precipitate an episode of an otherwise dormant bipolar illness. This also true of many other mental illnesses. A mild episode can remit spontaneously if the stress is removed or mitigated. I have seen this happen with my sister over the last six months. Thus, episodic mild depressions are no less facilitated via a genetic terrain than are chronic and severe presentations.
> Re. discontinuing Nardil in order to start on Venlafaxine, you`re right - there should be a certain gap (about a week, I believe) before Venlafaxine can be commenced. Having said that, a friend of mine has just cganged from Nardil to Vanlafaxine, and her psychiatrist has overlapped the two. I don`t think that she`s suffered any side effects from this - apart from the severe depression she has been experiencing for slightly longer than me (we are quite a comfort to each other). This isn`t the `correct` way to do it, I`m sure though.
All I can say is that I know of no way to confidently predict which people will experience a life-threatening reaction to such a combination and which will not. Once upon a time, in an act of desperation, I decided to take a nibble off a small piece of venlafaxine (Effexor) to see how it would react with the Parnate I was taking. Within ten or fifteen minutes, I experienced vertigo and I had to lay down. I couldn't get myself to sit up in bed. I became incoherent and hardly knew where I was. I made no sense at all when speaking to my parents. I told them not to worry about me, that I understood what I did wrong, and that I simply had to reboot the system. No problem.
I can't emphasize enough what a tiny amount of Effexor I bit off. Because of its short half-life, I chose Effexor purposely to test for the potential of developing serotonin syndrome when combining a serotonin reuptake inhibitor with an MAOI. If something went wrong, it should dissipate relatively quickly. It did. So did my notions of trying it ever again.
> Good luck with the Trimpramine (if you choose to take it).
> How long have you been depressed?
With the exception of a 6-month remission brought about by a combination of antidepressants, 24 years.
> Is it moderate/severe?
Severe. (I have been accused of being overly proud of this).
It was an honor to be assessed as being the most severely depressed research patient enrolled at the NIH during my nine-month stay there. Although there was this one guy who was an ultra rapid-cycler whose depressed state during the first three to six hours following a switch into his depressive phase seemed worse than mine. I envied him, though. After three days of depression, he would swing into a controllable hypomania that would last for eight. Gosh, what I could accomplish in eight days out of every eleven...
> Whatever, you have all my sympathy - it is truly a hideous illness.
Yup.
Thanks, Anna.
- Scott
poster:SLS
thread:55847
URL: http://www.dr-bob.org/babble/20010310/msgs/56545.html