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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by SDW on December 8, 2004, at 17:31:30
To anyone who has had an AD poop-out over the course of long-term treatment, or had residual dysthymia/anhedonia while on meds, I am wondering what others might consider doing in my shoes:For the last 2 years I have had a moderate chronic depression (dysthymia) characterized by:
Severe Fatigue
Apathy-Anhedonia
Zero Motivation
Memory /Concentration ProblemsI have been taking Amphetamine in order to function with the fatigue, but it does nothing for the depression.
I have used Parnate for severe major depression in the past and have had a great response, but it hasn’t helped me with this current illness. I have tried augmentation with Lithium, Lamictal, Cytomel. Cytomel was the only thing that offered any additional benefit, but it was modest. I tried a few SSRI’s and TCA’s in the past without much success.
I just restarted Parnate 3-4 weeks ago after a 5-month break hoping it might work at a higher dose. My doc will go up to 100 mg or so; I just went from 80 to 90. If it does not work after a few weeks at 100mg, I am considering:
MIRAPEX or Other DA Agonist
WELLBUTRIN
SNRI (CYMBALTA)
NARDIL(POSSIBLY)
My official diagnoses: Major Depression, Recurrent; Dysthymic Disorder.After 2 non-stop years, I am really desperate and I don’t want to sink into MD Episode. I am trying (slowly) to come to terms with the fact that Parnate may not help anymore, and maintain hope that something else will.
I appreciate any similar experiences /ideas / etc…
Steve
Posted by anxiety_free on December 8, 2004, at 19:16:31
In reply to AD Tolerance/Dysthymia, posted by SDW on December 8, 2004, at 17:31:30
Hi! I'm sorry to hear about your struggles. Have you tried augmentation with an anti-psychotic? Its not the most common augmentation, but its gaining popularity as docs find alot of these new meds work on resistant depression. Abilify has a lot of buzz around it as an AD augmenter, as does Risperdal. I take Cymbalta and I really like it...it works better since I added BuSpar, which I've read is another augmenting agent for ADs. Anyway, I wish you the best of luck!
Posted by Cruz on December 8, 2004, at 23:52:51
In reply to AD Tolerance, posted by anxiety_free on December 8, 2004, at 19:16:31
How long was Parnate effective in the past? Parnate has been about the only med that has been efficacious for me. Unfortunatly it quits helping after three months. Like you I have tried numerous augmentations with no success. For many years I have used Parnate for three months each spring when my business is quit demanding. The rest of the year I try other meds hoping to find something that will have long term efficacy. Currently I am taking 60mg Cymbalta,150mg Wellbutrin,1800mg Neurontin and its just a little bit helpfull. When Lyrica becomes available I plan to try it in the place of the Neurontin. I am certain my disorder is endocrine based but it looks like it will be quite a few years when its understood and treatments are available. Best wishes
Posted by SDW on December 9, 2004, at 9:54:06
In reply to Re: AD Tolerance, posted by Cruz on December 8, 2004, at 23:52:51
The effects of Parnate lasted close to one year the first time I took it, which was over 10 years ago. I raised the dose from 40mg to 60mg when it started to give out and got another 6 months out of it. I have taken it 3 times since. It seems to work for a while after I have been off it, but not for more than 6-9 months months, and it's only about 60 percent as effective as it used to be. If I can't get at least an 80 percent improvement of symptoms from a very high dose (90-100mg), I'll be looking for something else to take on a permanent basis.
Posted by gromit on December 9, 2004, at 20:34:17
In reply to AD Tolerance/Dysthymia, posted by SDW on December 8, 2004, at 17:31:30
> My official diagnoses: Major Depression, Recurrent; Dysthymic Disorder.
I didn't know you could have both MDD and Dysthymic Disorder, that seems to be the case with me too.
Rick
Posted by SDW on December 9, 2004, at 22:39:27
In reply to Re: AD Tolerance/Dysthymia » SDW, posted by gromit on December 9, 2004, at 20:34:17
I believe that the dignosis of Dythymic Disorder and Major Depression together are often referred to as "Double" depression. This term is used to describe someone who is chronically dythymic, but has periodic episodes of superimposed major depression. In my case, I have had several episodes of MD, but with full remission in most cases, and periods of being well. I now have had Dysthymia for 2 years but have not had MD within that time, so the 'Double depression' diagnosis doesn't seem to quite fit...
Posted by gromit on December 10, 2004, at 1:03:52
In reply to Re: Dysthymia/MDD, posted by SDW on December 9, 2004, at 22:39:27
Posted by jerrympls on December 10, 2004, at 18:03:25
In reply to AD Tolerance/Dysthymia, posted by SDW on December 8, 2004, at 17:31:30
>
>
>
>
> To anyone who has had an AD poop-out over the course of long-term treatment, or had residual dysthymia/anhedonia while on meds, I am wondering what others might consider doing in my shoes:
>
> For the last 2 years I have had a moderate chronic depression (dysthymia) characterized by:
>
> Severe Fatigue
> Apathy-Anhedonia
> Zero Motivation
> Memory /Concentration Problems
>
> I have been taking Amphetamine in order to function with the fatigue, but it does nothing for the depression.
>
> I have used Parnate for severe major depression in the past and have had a great response, but it hasn’t helped me with this current illness. I have tried augmentation with Lithium, Lamictal, Cytomel. Cytomel was the only thing that offered any additional benefit, but it was modest. I tried a few SSRI’s and TCA’s in the past without much success.
>
> I just restarted Parnate 3-4 weeks ago after a 5-month break hoping it might work at a higher dose. My doc will go up to 100 mg or so; I just went from 80 to 90. If it does not work after a few weeks at 100mg, I am considering:
>
> MIRAPEX or Other DA Agonist
> WELLBUTRIN
> SNRI (CYMBALTA)
> NARDIL(POSSIBLY)
>
>
> My official diagnoses: Major Depression, Recurrent; Dysthymic Disorder.
>
> After 2 non-stop years, I am really desperate and I don’t want to sink into MD Episode. I am trying (slowly) to come to terms with the fact that Parnate may not help anymore, and maintain hope that something else will.
>
> I appreciate any similar experiences /ideas / etc…
>
> Steve
>
Hi Steve-My story sounds a lot like yours. I haven't been on Parnate - but I was on Nardil. It worked great for about 3 months then nothing. I had COMPLETE loss of sexual desire and function (I'm male) while on it - and I do mean COMPLETE. I gained weight too.
Now I am on Cymbalta, Klonopin, Concerta and Mirapex. I'm only on a small dose of the Mirapex .5mg so I don't think it's doing much - however I have no side effects from it. I think Cymblata really causes more anxiety. It's not any better than Effexor or an SSRI in my opnion.
Good luck
Jerry
This is the end of the thread.
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