Posted by Lorraine on March 22, 2001, at 10:20:40
In reply to treatment resistant depression (part 2), posted by sweetmarie on March 22, 2001, at 7:24:44
Success story? Well, I was on Effexor for two years with a complete remission in my viewpoint. Then I got off it because the side effects (weight gain and sexual dysfunction) bothered my husband too much. LOL. Actually, they bothered me too. Then I was on Moclobemide and had a lovely experience on it for 4 months before the side effects (edginess and palpitations) wore me down.
Then a period of hope followed by despair began while me and my new pdoc started trying lots of different combos over a very short period of time. All of these were quick acting drugs (not SSRI's or MAOs) so a week or so on them was a sufficient test. I kept meticulous notes on the effects of each on my particular targets (energy, mood, cognitive functions, anhedona, and anxiety). I also tried very hard to pin point what was working. SSRI's were not working. Amphetamine worked for energy and cognitive function but not mood. Right now I am on Selegiline, which is an MAO B inhibitor and does not require dietary restrictions below 15 mg/day and Neurontin. I am having a very positive effect on this combo. Not quite home free, but SUBSTANTIALLY better. We started augmenting the Selegiline with Neurontin at 100 mg 3x day. I improved cognitively, energy-wise, but again had no mood support. My pdoc said that Neurontin at higher doses gives mood support. We went up to 300 mg 3x a day and "wala" "Houston, we have ignition" This combo needs to be tweaked. For one thing, I still have mild physical anxiety (difficulty taking deep breaths and chest pain). I talked with my pdoc yesterday and we are going to try adding Mirapex (a D2/D3 agonist)to the mix slowly and watch the effects. Mirapex has anti-depressant properties, is activating, and helps with anhedonia and sexual dysfunction. By the way Selegiline helps with sexual dsyfunction as well. So now the thought is perhaps if I add the Mirapex, I can decrease the Selegiline a tad and ease the foot off the amphetamine peddle possibly lessen the physical anxiety (which I believe that Selegiline aggravates mildly). If this doesn't work then maybe we add Pindolol (a beta blocker) to the mix for the physical anxiety. Meanwhile, I have stepped up the aerobic exercise for the anxiety.
So, yes, there is a light at the end of the tunnel (hell, I'm fully functional now--I actually "leave the house" LOL). Does it take work if you are treatment resistant? Yes, Yes, Yes, Yes. I think the trick is to find a very knowledgable and adventurous pdoc and take meticulous notes. Really think through what is working and why. The notes really are key.
My pdoc by the way ran a QEEG on me and ran it through a covariance analysis using a data base of 7000 other people to determine what drug combos were likely to work for me. He came up with amphetamine and mood stabilizer. Amphetamine, for his purposes, includes MAOs. Neurontin is a mood stabilizer. But among the mood stabilizers, I tried and rejected, Depakote and Lomictal. I pushed for Neurontin because it was known to have an anti-anxiety effect as well as a mood stabilizing effect in addition to the mood stabilizing effect. (That was my piece of homework.) I'm the one who pushed for the Selegiline retrial (it made me hyperventilate without the Neurontin augmentation). But I wanted the Selegiline because it's cognitive impact is so positive and the sexual support it provides helps with the side effects of other drugs--like Neurontin which I suspect dampens my sexual function.
Both me and my pdoc believe that the traditional MAOs would work on me. What we are trying to do is come up with an MAO that doesn't impair my sexuality, make me gain weight, or have dietary restrictions. I think we are finally marching in the right direction, but it has been an extraordinarily frustrating and difficult journey for me.
I hope that I have helped with this message.
poster:Lorraine
thread:57143
URL: http://www.dr-bob.org/babble/20010319/msgs/57158.html