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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by eln on April 16, 2003, at 2:38:37
Hi -
While I haven't tried every combination of every drug out there, I have given fair clinical trials to all of the modern SSRI and other antidepressants, with a huge supporting cast of add-ons, including a myriad of anti-psychotics and also lithium over the past 6 years.
I am in my two week wash out period after my trial with Parnate failed. I got all the way up to 60 mg/day, but was having really bad blood pressure spikes when I took my medicine and also some drug interaction problems from the low-dose Surmontil and Seroquel I was adding on (those were discontinued a while ago).
Although the Parnate allowed me a clear mind, it zapped my motivation. I couldn't get myself to do anything, and was really depressed besides that. And the weight gain really didn't help.So the question is... what next?
I've since had to take a leave of absence from graduate school because there was the possibility of severe depression hitting while I had no medications in my system. But now that I am safely away from school at my mom's house (on the other side of the country), I feel mostly fine. I want to get back to school ASAP so I can propose my PhD thesis. So, the next thing I do needs to work, and needs to work quickly.My doctor and I ruled out other MAOIs because of the blood pressure problems I was having.
Other choices seem to be Prozac and Abilify or ECT. I was on Prozac over 6 years ago, not a very high dose, and discarded it after 6 weeks due to some strange side effect (constant burping) that may or may not have been from the drug.
I am trying to find out if there is evidence that unilateral ECT works for patients with atypical depression. I also want to know what the stay well rate is if I take antidepressants following the initial course of ECT treatments but do not have maintenance ECT treatments.
Further complicating the matter is that I have been diagnosed just recently with PCOS. The hyperandrogenism can cause and aggravate depression. Unfortunately, the best way to treat that is with diet and exercise. I'm working on it. Or rather, I will start my low simple carbohydrate diet after I get my fair share of all that cheese I've been missing after 6 months on MAOIs.
Its also going to be hard to tell if any of the treatment I receive out at my mom's is working because I am generally in a better mood when not under the pressures of school.I'm looking for advice on where to go next:
- more drug trials that probably won't work long-term even if there is an initial response- ECT -- unilateral, bifrontal, or bilateral
(and after ECT - continue SSRI only, or have maintenance treatments)The other option, which no one but me seems to think is an option is to drop out of school and get a less stressful life. When I'm not stressed out by school and everything I'm not getting done there, I am ok most of the time. Not that I wouldn't require treatment, but probably even minimal treatment may work.
Suggestions? Thanks for reading this long post.
-E
Posted by ace on April 16, 2003, at 2:45:06
In reply to Treatment resistant atypical depression-what next?, posted by eln on April 16, 2003, at 2:38:37
> Hi -
> While I haven't tried every combination of every drug out there, I have given fair clinical trials to all of the modern SSRI and other antidepressants, with a huge supporting cast of add-ons, including a myriad of anti-psychotics and also lithium over the past 6 years.
>
> I am in my two week wash out period after my trial with Parnate failed. I got all the way up to 60 mg/day, but was having really bad blood pressure spikes when I took my medicine and also some drug interaction problems from the low-dose Surmontil and Seroquel I was adding on (those were discontinued a while ago).
> Although the Parnate allowed me a clear mind, it zapped my motivation. I couldn't get myself to do anything, and was really depressed besides that. And the weight gain really didn't help.
>
> So the question is... what next?
> I've since had to take a leave of absence from graduate school because there was the possibility of severe depression hitting while I had no medications in my system. But now that I am safely away from school at my mom's house (on the other side of the country), I feel mostly fine. I want to get back to school ASAP so I can propose my PhD thesis. So, the next thing I do needs to work, and needs to work quickly.
>
> My doctor and I ruled out other MAOIs because of the blood pressure problems I was having.
>
> Other choices seem to be Prozac and Abilify or ECT. I was on Prozac over 6 years ago, not a very high dose, and discarded it after 6 weeks due to some strange side effect (constant burping) that may or may not have been from the drug.
>
> I am trying to find out if there is evidence that unilateral ECT works for patients with atypical depression. I also want to know what the stay well rate is if I take antidepressants following the initial course of ECT treatments but do not have maintenance ECT treatments.
>
> Further complicating the matter is that I have been diagnosed just recently with PCOS. The hyperandrogenism can cause and aggravate depression. Unfortunately, the best way to treat that is with diet and exercise. I'm working on it. Or rather, I will start my low simple carbohydrate diet after I get my fair share of all that cheese I've been missing after 6 months on MAOIs.
>
> Its also going to be hard to tell if any of the treatment I receive out at my mom's is working because I am generally in a better mood when not under the pressures of school.
>
> I'm looking for advice on where to go next:
> - more drug trials that probably won't work long-term even if there is an initial response
>
> - ECT -- unilateral, bifrontal, or bilateral
> (and after ECT - continue SSRI only, or have maintenance treatments)
>
> The other option, which no one but me seems to think is an option is to drop out of school and get a less stressful life. When I'm not stressed out by school and everything I'm not getting done there, I am ok most of the time. Not that I wouldn't require treatment, but probably even minimal treatment may work.
>
> Suggestions? Thanks for reading this long post.
> -E
>Despite what your Dr. says I would say Nardil is the next one. It is a brilliant AD.
Good Luck!
Ace.
Posted by HenryO on April 16, 2003, at 3:44:46
In reply to Treatment resistant atypical depression-what next?, posted by eln on April 16, 2003, at 2:38:37
LAMICTAL
Posted by noa on April 16, 2003, at 9:14:01
In reply to Treatment resistant atypical depression-what next?, posted by eln on April 16, 2003, at 2:38:37
>>Further complicating the matter is that I have been diagnosed just recently with PCOS.
When you were worked up for the PCOS, did they also screen for other endocrine disorders?
How is your thyroid? Hypothyroidism can also cause depression, and shares many of the "atypical" features. It is often underdiagnosed, too, because of doctors' over-reliance on statistical norms for TSH.
I only started to really get what I needed out of my antidepressants when my hypothyroidism was properly diagnosed and treated.
For more info, see:
http://groups.yahoo.com/group/psycho-babble-tips/links/Noa_s_thyroid_links_000963272558/
Posted by Ritch on April 16, 2003, at 10:34:06
In reply to Treatment resistant atypical depression-what next?, posted by eln on April 16, 2003, at 2:38:37
> Hi -
> While I haven't tried every combination of every drug out there, I have given fair clinical trials to all of the modern SSRI and other antidepressants, with a huge supporting cast of add-ons, including a myriad of anti-psychotics and also lithium over the past 6 years.
.....
> Suggestions? Thanks for reading this long post.
> -E
>
I get bipolar depressions that are atypical in nature and found that no single AD seems to be very helpful. AP's just cloud my brain and make me apathetic. Low-dose combos of different class AD's have worked the best for me thus far. I don't know if you have already tried this stuff in combo or not, but... what about:1) Nortriptyline+Effexor or
2) Nortriptyline+Effexor+Wellbutrin or
3) Effexor+Wellbutrin or
4) Nortriptyline+Wellbutrin
5) Add a little buspirone to any of the prev. 4
????Of course it is just personal response here, but Effexor seems to pack the most punch out of the SRI family, and Nortriptyline seems to punch the hardest out of the TCA's, and Wellbutrin seems to do something helpful in combo with either or both that is special.
"Mood stablizer"-wise, you might consider adding on to the above either Lamictal, Tegretol, or Trileptal, or Neurontin.
Fishoil add + SAMe + L-tyrosine + DLPA might be worthy of looking into.
Posted by chad_3 on April 16, 2003, at 13:20:53
In reply to Treatment resistant atypical depression-what next?, posted by eln on April 16, 2003, at 2:38:37
Hi there -
At risk of overposting on nardil (my 2nd or 3rd right now) - but ....
Consensus among psychiatrists is that the best med for atypical depression is nardil (though they don't also believe nardil is best for Social Phobia which it is ... those 2 disorders are where Nardil outdoes other antidressants).
For atypical depression - characterized (as in SP) - by rejection hypersensitivity (and oftetimes passivity as well) - Prozac is good, parnate supposedly is pretty good - but nardil is king.
You mentioned hypotension on Parnate. This is less a problem with Nardil. You can also go low dose Nardil and add Ritalin - this may help that problem and also effective for atypical depression. Some thoughts anyway ... but if you haven't tried nardil you haven't tried the most eeffective med for atypical depression....
Chad
http://www.socialfear.com/
> Hi -
> While I haven't tried every combination of every drug out there, I have given fair clinical trials to all of the modern SSRI and other antidepressants, with a huge supporting cast of add-ons, including a myriad of anti-psychotics and also lithium over the past 6 years.
>
> I am in my two week wash out period after my trial with Parnate failed. I got all the way up to 60 mg/day, but was having really bad blood pressure spikes when I took my medicine and also some drug interaction problems from the low-dose Surmontil and Seroquel I was adding on (those were discontinued a while ago).
> Although the Parnate allowed me a clear mind, it zapped my motivation. I couldn't get myself to do anything, and was really depressed besides that. And the weight gain really didn't help.
>
> So the question is... what next?
> I've since had to take a leave of absence from graduate school because there was the possibility of severe depression hitting while I had no medications in my system. But now that I am safely away from school at my mom's house (on the other side of the country), I feel mostly fine. I want to get back to school ASAP so I can propose my PhD thesis. So, the next thing I do needs to work, and needs to work quickly.
>
> My doctor and I ruled out other MAOIs because of the blood pressure problems I was having.
>
> Other choices seem to be Prozac and Abilify or ECT. I was on Prozac over 6 years ago, not a very high dose, and discarded it after 6 weeks due to some strange side effect (constant burping) that may or may not have been from the drug.
>
> I am trying to find out if there is evidence that unilateral ECT works for patients with atypical depression. I also want to know what the stay well rate is if I take antidepressants following the initial course of ECT treatments but do not have maintenance ECT treatments.
>
> Further complicating the matter is that I have been diagnosed just recently with PCOS. The hyperandrogenism can cause and aggravate depression. Unfortunately, the best way to treat that is with diet and exercise. I'm working on it. Or rather, I will start my low simple carbohydrate diet after I get my fair share of all that cheese I've been missing after 6 months on MAOIs.
>
> Its also going to be hard to tell if any of the treatment I receive out at my mom's is working because I am generally in a better mood when not under the pressures of school.
>
> I'm looking for advice on where to go next:
> - more drug trials that probably won't work long-term even if there is an initial response
>
> - ECT -- unilateral, bifrontal, or bilateral
> (and after ECT - continue SSRI only, or have maintenance treatments)
>
> The other option, which no one but me seems to think is an option is to drop out of school and get a less stressful life. When I'm not stressed out by school and everything I'm not getting done there, I am ok most of the time. Not that I wouldn't require treatment, but probably even minimal treatment may work.
>
> Suggestions? Thanks for reading this long post.
> -E
>
Posted by eln on April 16, 2003, at 18:36:06
In reply to best med for atypical depression, posted by chad_3 on April 16, 2003, at 13:20:53
> Consensus among psychiatrists is that the best med for atypical depression is nardil (though they don't also believe nardil is best for Social Phobia which it is ... those 2 disorders are where Nardil outdoes other antidressants).
>
> For atypical depression - characterized (as in SP) - by rejection hypersensitivity (and oftetimes passivity as well) - Prozac is good, parnate supposedly is pretty good - but nardil is king.
>
> You mentioned hypotension on Parnate. This is less a problem with Nardil. You can also go low dose Nardil and add Ritalin - this may help that problem and also effective for atypical depression. Some thoughts anyway ... but if you haven't tried nardil you haven't tried the most eeffective med for atypical depression....
Thanks for the post, but it wasn't really hypotension I had the problem with but rather hypertension. My blood pressure was normal until I took the Parnate, when it spiked close to 150/100 after the second and third doses of the day. (I was taking 20 mg 3 times a day). I tried spreading out the doses with little help.
My understanding was that my risk of the same type of thing happening with Nardil was fairly high, as I seem to be very sensitive to these types of things.
The other weird thing on Parnate is that towards the end, my depression resembled regular depression rather than atypical depression.Now that I am at the one-week mark, I can start Nardil if I wanted to, but I'm not sure I can afford the time for a full trial of a medication that has a large probability of having unbearable side effects (the hypertension caused me to have to lay down in a dark quiet room for several hours a day -- not very good for productivity!)
Thanks,
E
Posted by bretbe on April 17, 2003, at 0:14:26
In reply to Treatment resistant atypical depression-what next?, posted by eln on April 16, 2003, at 2:38:37
Okay, I'm going to be the outcast to suggest a non-med method...if you feel better away from school, why not stop and do something else? If quitting school would cure my illness, I'd do it right away! You can't put a price on feeling well. Maybe you really genuinely need a break. I dropped out of Phd program and it didn't cure me, but I didn't kill myself like I was seriously contemplating at the time and I certainly don't regret dropping out. Look, it's your life and you only have one, why make it Hell if you know how it can be better. At least take some time off...maybe you'll feel better about finishing the phd later. At least you can have more time to experiment with other meds.
Well, that's my two cents. Good luck to you!
Posted by Merci on April 17, 2003, at 0:56:02
In reply to Re: Treatment resistant atypical depression-what next? » eln, posted by ace on April 16, 2003, at 2:45:06
to echo Ace, Nardil is a brilliant AD and might be worth a try. when I tried Parnate, I had immediate blood pressure problems, however, with Nardil I have had none. perhaps the same would be true of you - your reaction to Parnate isn't necessarily indicative of your reaction to all MAOI's. hope this information helps. good luck.
This is the end of the thread.
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