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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by HeidiK on November 9, 1999, at 18:02:48
I have been suffering from the symptoms of dysthymia for as long as I can remember (back to age 5 or so -- about 29 years). I have been in weekly individual psychotherapy for approximately 10 years but recently cut down to once a month.For many years, I was extremely reluctant to even try drug therapy. I finally gave in only after a major depressive episode about a year ago.
At that point, I was put on Wellbutrin SR 300mg/day, increased to 400mg/day, then augmented with Prozac 10mg/day and then increased to 20mg/day.
I have very low motivation levels most of the time, virtually no sex drive and tend to eat compulsively (seldom bingeing, but almost always eating beyond satiety -- and I'm currently at more than double my ideal weight.)
The Wellbutrin helped the major depression tremendously, and I decided to stick with it in hopes of improving the underlying dysthymia. Shortly after the dose was increased to 400mg, but before Prozac was added, I was able to climax twice in one evening with my husband. This is unremarkable for many people, but in 16 years of sexual activity, I've only achieved orgasm with a partner a total of about a half-dozen times. Needless to say, I was very pleased and surprised. My husband was downright giddy for days.
Unfortunately, the benefit was short-lived. After losing my ability to even masturbate to orgasm (due, I presumed, to the Prozac), I dropped back to 10mg and then discontinued it entirely. However, the sexual benefits I attributed to the Wellbutrin did not reappear.
I've bounced around quite a bit since then -- tapering off the Wellbutrin over a period of a few weeks, staying off for about 2 months, going back on for a while, then going off cold turkey (Yeah, I know. Bad idea. But I was out of meds and intimidated about going back to the prescribing psychiatrist.) I also took a B-complex supplement and Betaine HCG for a while, hoping for some SAM-e/Methionine benefits, but didn't notice any improvement.
Now, I am off everything. I even stopped taking birth control pills about 2 weeks ago because I've noticed some increase in libido during the one week in my cycle when I don't take them, and I've also read that they can cause or at least exacerbate depression. Since my husband and I rarely have sex more than once every other month, pregnancy is not a concern.
Bottom line is, I'm back to feeling blah nearly all the time, and have a motivation level and sex drive that stay parked around zero. I want to feel better, but the more I read, the more psychopharmacology seems to be a great big juggling act -- meds, dosages, side effects, benefits -- and I am very discouraged by the length of time it often takes to see results (also, how difficult it can be to recognize the effects because they can occur so subtly and over such a long period.)
However, based on my experiences on medication (improvements in motivation, concentration and mood, lessening of compulsive eating tendencies, occasional sexual benefits), I do believe that there is more to my condition than a lack of motivation and low self-esteem and that form sort of chemical intervention is warranted.
If anyone can give me some ideas that won't make me more discouraged and frustrated than I already am, I'm all ears.
Sorry for the ramble, but I really don't know where to turn at this point. Thanks for taking the time to read.
Posted by andrewb on November 9, 1999, at 21:19:33
In reply to Long-Term Dysthymia -- Please Help, posted by HeidiK on November 9, 1999, at 18:02:48
I've read that by far the greater proportion of dysthymics can be helped with medication. I certainly have been. There are a lot of options you have yet to try, so take heart.
Why are you intimidated my your current psychiatrist? To get better you will probably need the help of a psychiatrist and it helps to get the best psychiatric care that is out there. You may find such a psychiatrist aligned with a major university or hospital. He or she will have experience with refractory depressions and may be self described as a psychopharmacoloigist.
I also would like to mention that fatigue, low motivation, low mood, weight gain, low concentration and lack of libido are all symptoms of hypothyroidism. If you haven't already done so, get your free thyroid hormone levels checked. Note that you need to get your FREE T4 and T3 levels checked as total thyroid hormone levels can be unreliable. Even if you do not have low levels of thyroid hormones, you may benefit from taking T3 for fatigue and depression. It is a fairly common augmentation strategy.
Posted by Noa on November 10, 1999, at 3:35:05
In reply to Re: Long-Term Dysthymia -- Please Help, posted by andrewb on November 9, 1999, at 21:19:33
Add TSH levels to those tests. A high TSH can indicate hypothyroid.
Posted by HeidiK on November 10, 1999, at 10:23:07
In reply to Re: Long-Term Dysthymia -- Please Help, posted by Noa on November 10, 1999, at 3:35:05
The first thing the psychiatrist did was to have my thyroid levels checked. Everything came back normal.
As for why I'm intimidated, I feel guilty about changing my medication without consulting him and don't want to get scolded. (Real mature, I know.)
Posted by Bob on November 10, 1999, at 15:42:53
In reply to Re: Long-Term Dysthymia -- Please Help, posted by HeidiK on November 10, 1999, at 10:23:07
So, you've been dysthymic for 29 years and on meds sporadically for less than one.
I don't mean to slam you at all, HeidiK, so please don't take it that way. Just take a look at the two periods.
I know that once you finally get up the gumption to take that step after so many years, you want things to work right away. If you're as lucky as my brother, they do. If you're as lucky as me, it'll take a couple of years.
Did you get along well with your pdoc? You may want to look at some threads on picking a psychiatrist and consider the same issues yourself. If he was helping you, what are you waiting for? You know better now about sticking with your meds, so make an appointment and just get it over with. Besides being stuck in the same old hole you've been in for 29 years, feeling guilty about being noncompliant with your meds is just going to dig the hole deeper instead of help you out.
You had the strength and the courage to do it once. It sounds like you have a supportive husband as well. Draw on those resources and just do it.
(Nikes are optional)
Bob
Posted by Heidi on November 10, 1999, at 20:14:32
In reply to Re: Long-Term Dysthymia -- Please Help, posted by Bob on November 10, 1999, at 15:42:53
No offense taken, Bob. I am acutely aware of how ridiculous it sounds to have suffered so long and yet still be hopeful of a quick fix. After so many years agonizing over whether to try medication at all, I feel like I should somehow get cosmic 'credit for time served' now that I've taken the step.The problem for me with medication has been that I have relatively good spells with some regularity, and when it takes weeks or months to see results from medication, it becomes difficult to decide whether to attribute the differences I experience differences to the meds or my normal ups and downs. My tendency is to WANT the improvements NOT to be drug-related (the "I can do this on my own syndrome"), and so I go off, thinking that things will be better on their own.
The biggest frustration, though is the inability to "just do it" when I'm not on meds. If I had the motivation to do the things that I know would be helpful to me, I wouldn't be where I am.
There are days (weeks, months...) when I feel like there is a force-field around whatever it is that I should be doing, and I can't bring myself to even touch it, let alone get started. Once I can crack through that barrier, I always marvel at how much energy I have spent avoiding the task, as compared to the amount of energy it takes to simply do what needs to be done, but no matter how many times I remind myself of the fact, I still repeat the cycle over and over.
Thank you for the mild verbal "kick in the pants" about dealing with the guilt of going back to the psychiatrist. I know it's what I need to do.
Posted by Bob on November 10, 1999, at 21:55:31
In reply to "Just Do It", posted by Heidi on November 10, 1999, at 20:14:32
Sticking with the sports theme ...
If you're not making any yardage trying to punch it up the middle, maybe it's time for an end around.
Do you talk about this with your husband? Can he make the call for you? How about calling after hours -- will you get voice mail or a service where you can leave a message instead having any concern about talking with your pdoc right away? Put it in writing? Just show up at his office?
Taking that first step -- making the first apointment about a year ago -- was something you need to see as taking control, not surrendering it. The same with the second step, going back and making the "second" appointment.
I didn't want to surrender that control over to medications either. But I was deluding myself in thinking that I had any control in the first place. I was being controlled by my disorder. Delegating authority still means YOU are in control.
The same is true of bills for me, just like meds. I thought that *I* had to do them, that I had to have my checkbook balanced perfectly before I could spend any *real* money -- all sorts of little rituals and superstitions that kept me from paying anything on time. Then, I turned my credit cards over to a debt management firm and my student loans over to the US DOE, and now I have three bills that I can all pay electronically (which I think is just too cool), Amex being the third. Surrendering control over the details has given me back control over the big picture -- I've got enough courage from taking action and enough stability from the results of those actions that for the first time in my 19 years as an "adult" I might actually be able to come up with a monthly budget for the first time.
So, if you can't "just do it" by yourself, bring in your husband, leave a message, give someone else the power to take the second step for you.
Hang in there,
Bob
This is the end of the thread.
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