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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by JohnL on June 25, 1999, at 21:24:24
OK. I'm going back to square one. Next week I will see my doctor and request a full work-up for physical causes of depression. It's been 5 years since a bloodtest. I don't want to miss anything. What should I ask about? Thyroid, upper 1/4 of normal range, understand that. Cortisol? Ummm, what else? DHEA? Testosterone? I'm sure my doc will know, but I would like to know what you all think is important to check for.
Background: Dysthymic since childhood. First major depression with psychotic features diagnosed in 1995. Labelled bipolar, though any possible hypomanic episodes were short, mild, and questionable at best. Always outpatient, able to function. Was OK on Paxil for a year. But impotence and bad sleep and a seemingly total recovery caused me to quit. Depression returned in 3 months, slow but sure. Since then, lots of counseling, Zoloft, Prozac, Serzone, Effexor, Wellbutrin, Pamelor, Remeron, Vivactil, Moclobemide, St. Johnswort, 5HTP, SAMe, and various combinations. Four problems: 1)Not effective at appropriate dose, 2) Disabling sexual side effects, 3)Terribly loud ringing in the ear, 4)Depression actually worsened by antidepressant. With all my sensitivities and atypical reactions to drugs, I can't help but think maybe there's something I overlooked. Thus the thought to get back to basics. Most recently went on Paxil again, hoping to augment with Naltrexone, but after just one week I was reminded of all the reasons I quit Paxil years ago that I forgot about...my hair falls out badly, I sleep badly even when I sleep all night, and of course that sex thing.
If tests come out OK, I will discuss Buspar+Pindolol(saw a NYU study showing this combo to work great and fast, especially on symtpoms of apathy/anhedonia, MY symptoms!); or a stimulant; or maybe a second stab at Serzone; or, hey, I remember a doctor once saying Anafranil was great for sex. Was he being sarcastic, or it that true? And I still have a bottle of Naltrexone to try with whatever.
Questions: 1. What tests should I ask for?
2. Anyone know if Anafranil (Clomipramine) is good for sex? Or was the doc joking.
3. Any other input?You all are great. Thank you much for your help. JohnL.
Posted by Elizabeth on June 25, 1999, at 23:35:02
In reply to What tests do I need?, posted by JohnL on June 25, 1999, at 21:24:24
Hi John.
I'm not sure what tests are needed offhand. I got diagnosed with depression when I was 14 and I don't remember all the things they did to me :-> except there were a lot of neurological tests because I was having headaches. (The headaches vanished a couple weeks after I started taking Prozac.)
I've read about Buspar+pindolol too. It sounds very promising. (I used pindolol to accelerate an AD response, with success.) Don't be afraid to push the Buspar dose as high as you need to.
The "atypical response to ADs" thing suggests to me that maybe what you're dealing with is not dysthymia but cyclothymia. Something you might try is Lamictal, as it's supposed to be both an AD and a mood stabilizer.
The other thing is, dysthymia often takes longer to heal with ADs than major depression does. (This sort of makes sense intuitively, I guess.) So you have to give antidepressants a long time. That's if they don't seem to be working at first, though, not if they make you worse. Did all of those ADs you tried make the depression worse? If not, for how long did you try the other ones?
Another thing I'd consider is going back to Paxil and using Wellbutrin or something to deal with the sexual dysfunction.
BTW as far as I know, Anafranil causes the same sex problems as the SSRIs. However, I think I read somewhere that a rare "adverse" reaction (well, side effect anyway) is having an orgasm when you yawn.
Posted by Cynthia on June 26, 1999, at 0:32:19
In reply to What tests do I need?, posted by JohnL on June 25, 1999, at 21:24:24
>Hi JohnL,
Anafranil was great for my sexlife. My sex drive increased dramatically and I climaxed easily. Unfortunately it exacerbated my OCD.
Cynthia
Posted by andrewb on June 26, 1999, at 2:52:35
In reply to What tests do I need?, posted by JohnL on June 25, 1999, at 21:24:24
know, but I would like to know what you all think is important to check for.
>
> Background: Dysthymic since childhood. First major depression with psychotic features diagnosed in 1995. Labelled bipolar, though any possible hypomanic episodes were short, mild, and questionable at best. Always outpatient, able to function. Was OK on Paxil for a year. But impotence and bad sleep and a seemingly total recovery causltrexop. JohnL.First of all thank you for your posts, I’ve found them interesting
I’d like to throw at you the name a few other meds to consider for dysthymia. I believe I have dysthymia (low energy or fatigue, low self esteem, poor concentration, feelings of hopelessness) and therefore have been interested in what’s out there that helps. Here are four meds used for treating dysthymia at times your doctor may want to consider prescribing: amisulpride, amineptine, nardil and triflouperazine.
Amineptine has helped me a lot. And, thank you, it has no sexual side effects (I take a small dose 50mg/day). Amisulpride, like amineptine, works on the dopamine pathways, but has more specific action on the D2-D3 receptors (have you ever tied anything with specific action on the dopamine pathways?), which may mean it is cleaner acting. I get the impression from what little I’ve read that men tolerate amisulpride very well at doses appropriate for dysthymia- it’s a different story for women. I’ve also read triflouperazine at 1mg/day acts like amisulpride. Nardil, an older non-reversable MAO-I, may help with low energy, low motivation, anhedonia, and poor concentration.
Posted by JD on June 26, 1999, at 16:44:59
In reply to What tests do I need?, posted by JohnL on June 25, 1999, at 21:24:24
I've gone through a similar round
of tests lately, though unfortunately
not much very conclusive came out
of them! Among other things,
I'd recommend complete
thyroid, DHEA, cortisol, and
testosterone tests. With cortisol, try
to get 8am, 4pm, and 24-hour
excretion levels, as they can reveal
different things. (Have you already
done a suppresion test, too?)With dysthymia/anhedonia and the
med regimens you describe, there's
some reason to suspect a dopamine
component. Though you've tried
Wellbutrin, I wonder if you've ever
tried an MAOI, which would seem
logical to me. Amineptine and
amisulpride perhaps merit trials
too, perhaps even one of the newer
dopamine agonists starting to attract
some attention for use in depression.
Naltrexone augmentation
has clearly worked wonders for
certain people, too--from what I
understand, it doesn't always have
to combined with SSRIs, either.Wishing you the best,
JD> OK. I'm going back to square one. Next week I will see my doctor and request a full work-up for physical causes of depression. It's been 5 years since a bloodtest. I don't want to miss anything. What should I ask about? Thyroid, upper 1/4 of normal range, understand that. Cortisol? Ummm, what else? DHEA? Testosterone? I'm sure my doc will know, but I would like to know what you all think is important to check for.
>
> Background: Dysthymic since childhood. First major depression with psychotic features diagnosed in 1995. Labelled bipolar, though any possible hypomanic episodes were short, mild, and questionable at best. Always outpatient, able to function. Was OK on Paxil for a year. But impotence and bad sleep and a seemingly total recovery caused me to quit. Depression returned in 3 months, slow but sure. Since then, lots of counseling, Zoloft, Prozac, Serzone, Effexor, Wellbutrin, Pamelor, Remeron, Vivactil, Moclobemide, St. Johnswort, 5HTP, SAMe, and various combinations. Four problems: 1)Not effective at appropriate dose, 2) Disabling sexual side effects, 3)Terribly loud ringing in the ear, 4)Depression actually worsened by antidepressant. With all my sensitivities and atypical reactions to drugs, I can't help but think maybe there's something I overlooked. Thus the thought to get back to basics. Most recently went on Paxil again, hoping to augment with Naltrexone, but after just one week I was reminded of all the reasons I quit Paxil years ago that I forgot about...my hair falls out badly, I sleep badly even when I sleep all night, and of course that sex thing.
>
> If tests come out OK, I will discuss Buspar+Pindolol(saw a NYU study showing this combo to work great and fast, especially on symtpoms of apathy/anhedonia, MY symptoms!); or a stimulant; or maybe a second stab at Serzone; or, hey, I remember a doctor once saying Anafranil was great for sex. Was he being sarcastic, or it that true? And I still have a bottle of Naltrexone to try with whatever.
>
> Questions: 1. What tests should I ask for?
> 2. Anyone know if Anafranil (Clomipramine) is good for sex? Or was the doc joking.
> 3. Any other input?
>
> You all are great. Thank you much for your help. JohnL.
This is the end of the thread.
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