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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Cole_B on December 18, 2004, at 17:01:26
Hi All, I'm a newbie to this board but not, alas, to depression. I've had some "down" periods in life, brought on by external events, though nothing that required hospitalization or even medication. Still, I do think I'm vulnerable to depression. Anyway, I got Lyme disease some years back - it was treated farily aggressively once I was diagnosed, although the diagnosis was delayed, unfortunately - and since then my depressions have been very different in nature; specifically, they almost always seem endogenous, coming on without an outside trigger. They are more frequent, more intense and more baffling because I can rarely tie them into life events. I was hospitalized a few years ago and put on Effexor, which seemed quite effective for a couple of years but now has seemed to lose its potency for me. I can't tolerate a higher dose because I get akathisia, and the same thing happens with the SSRIs and TCAs that I've tried. (It's possible my nervous system has been damaged by the Lyme, limiting my tolerance.) Anyway, I'm going through a difficult period now and feeling a little freaked because there don't seem to be too many meds out there left for me to try. I'm even considering ECT, since my grandfather had it on a few occasions throughout his life and it basically raised him from the dead each time. (Remarkable to see, really). I would call my depresions unipolar, since I don't ever seem to have manic episodes, but I was wondering if any unipolar people here have had success with, say, Lamictal. Anyone? Anyone? Bueller? Thx.
Posted by banga on December 18, 2004, at 18:39:17
In reply to Depression - Night and Day, posted by Cole_B on December 18, 2004, at 17:01:26
I think that there are many many options to still explore before thinking of ECT. I too have unipolar depression, similar life pattern as you describe--initially seemed to be triggered more by outside events, now has a much more endogenous feel. If one were to formally diagnose me, I would be Major Depressive Disorder, Chronic, and Generalized Anxiety Disorder.
I have had partial responses to a couple of SSRIs and TCAs, but it has been far from the magic bullet. I have been on some of the atypical antipsychotics (Risperidone, Geodon), that at least short-term did wonders for me--no anxiety, much less depression; others have found them to be a long-term answer.
I am now trying the first mood stabilizer ever--Lamictal. The second week I already felt better. SOmehow calmer and without these dramatic swings into despair. It is still too early to tell how helpful overall it will be, but I am encouraged.
My medication plan has switched from oncentrating on "which antidepressant" to "which mood stabilizer and which stimulant?" I personally feel that monotherapy with something like an SSRI has not been the best approach. In my mind, I equate the brain to an ecosystem---let's say a lake. And one day you notice that the lake is so very murky, and there are not many fish. You decide--hey it needs snails to clean it up and feed the fish! So you add a whole bunch of snails and sure enough the lake is clearer, and there are more fish. But then you see that there are way too many snails, so you add a bunch of fish. And it gets better, but then the fish eat all the snails, the lake becomes murky again, the fish begin to die out....and it's lousy again.
It would have been better to think it through, add a little of this and that-- to influence but not overwhelm the balance in the lake by adding too much of one thing. All the elements are interconnected; pushing in too much of one may have repurcussions down the line.
sorry about the long analogy, but I simply am becoming very skeptical of monotherapy, now thinking a little of two or three things may be better than a lot of one.
To get back to the original point, many unipolarly depressed people seem to have tried and felt better on a mood stabilizer (often in combination with an antidepressant) than they did on an antidepressant alone. And the atypical antipsychotics are used more and more too. There are many options to still try out--either alone or combined with an antidepressant.
By the way, what do you know about the possible long-term effects of Lymes disease on neurochemistry? Have you researched it, spoken to some docs, found out what may have helped previous people? Have you also considered your family history, to get an idea what the chances are that you inherited the depression? YOu probably have done this, but on the off-chance you havent I thought Id mention it...could give some clue as to what may work best.
For me, family history screams "inheritance!", but with the number of depression, bipolar, Attention Deficit, and anxiety--disordered people among my relatives, it doesn't help zeroing in on the most likely central cause(s) of my difficulties!!
Sorry for the long post!
Posted by Phillipa on December 18, 2004, at 19:28:54
In reply to Re: Depression - Night and Day, posted by banga on December 18, 2004, at 18:39:17
I can't believe I'm reading this! I too, have chronic Lyme's Disease. I have been hospitalized for depressions since it was discovered, this I might add after no pdoc would believe that I thought I still had Lyme's Disease. Guess what? I did! Tried Rocephin IV and was discontinued due to side-effects due to rapid administration of the med. Infection Control doc thought it was from the med. Problem was the psych RN's didn't know how to use an IV pump so they just let it flow in in 5-l0minutes instead of over an hour. Put me on Biaxin by mouth Still came upo positive until last March. They stopped the Biaxin. Just went back to Head of Infection Control because I have experienced so many wierd things since March, like losing my taste, and none of my anti-anxiety meds worked any more and I have become so spacey and agorphobic I can't let my husband out of my sight. Had to switch pdocs because mine gave up practice in area. Only one in area put me on Cymbalta and I became a non-feeling zombie. I am weaning myself off Cymbalta and I can cry for the first time in a year. I am not doing well emotionally and hope the tests IF Control doc ran will yield some answers. He did an MRI of head, sinuses, and pituitary gland, plus Lyme's titer and ANA {elevated at l:640}. I'm going on and on so I'll quit but to add my Paxil quit working when I felt ill with the disease about 7 years ago and it's been downhill ever since. Thanks for listening.
Posted by Phillipa on December 18, 2004, at 20:04:05
In reply to Re: Depression - Night and Day, posted by banga on December 18, 2004, at 18:39:17
Banga; Do you know where I can research the neurological effects of Lyme's? I bought books a while back on the subject and all they say is Bell's Palsy. Also an ANA is an indicator of autoimmune disease or other infection like Lyme's. When on IV it was 28080. Normal is below l:80. Thanks, I read your other posts and respect your knowledge. Also where are you ed uk,Lar,Linkage to name a few! You're all GREAT!
Posted by ed_uk on December 19, 2004, at 4:43:38
In reply to Re: Depression - Night and Day, posted by Phillipa on December 18, 2004, at 20:04:05
Hi!
I have a textbook which lists some of the treatments for the neurological features of Lyme disease....
28 days of ceftriaxone 2g/day (Rocephin)
or 28 days of high dose IV penicillin G
or 28 days of IV cefotaximeTreatment of chronic neurological problems can be continued with 100mg doxycyline twice daily (orally) or with the highest tolerated dose of oral amoxicillin.
Ed.
Posted by Phillipa on December 19, 2004, at 11:06:01
In reply to Re: Lyme disease, posted by ed_uk on December 19, 2004, at 4:43:38
So, they don't favor Biaxin over there? This Infection Control Doc is supposed to be the best in NC. I will wait to see what the latest Lymes Titer result is and pass along your info. My books say the same thing, and I wondered about the Biaxin. In all fairness I must say, he put me on doxycycline and I developed horrible sunburn without being in the sun. Do the neurological effects present as depression? Will they go away if Titer is normal and you take drugs anyway? you are such a wealth of knowledge. I wish you were a Md in USA! You would be a millionaire! Thank-You, Thank-You! Phillipa
Posted by Cole_B on December 19, 2004, at 11:16:36
In reply to Re: Depression - Night and Day, posted by banga on December 18, 2004, at 18:39:17
> By the way, what do you know about the possible long-term effects of Lymes disease on neurochemistry? Have you researched it, spoken to some docs, found out what may have helped previous people? Have you also considered your family history, to get an idea what the chances are that you inherited the depression? YOu probably have done this, but on the off-chance you havent I thought Id mention it...could give some clue as to what may work best.
First of all, thanks to all for your responses.
Yes, I have some family history of depression - my grandfather (maternal), as I mentioned in my original post, and my father had a chronic low level depression (and anxiety). I don't doubt that these are factors in my condition.
My problem is that there are so many confounding factors now. For example, I awake every morning shaking like a leaf - is this leftover Lyme, agitated depression, or a reaction to the Effexor? I've had this before in the last year and it has always remitted eventually, but it freaks me out. Also it seems to parallel my depressions, but not exactly. This last episode started out feeling like depression but has now progressed to the shaking and despair. Last year I had a depression, my doc raised the Effexor dose and I eventually felt better but then developed the shaking, which remitted when I cut back the dose. It's all so *%$#@! complicated. Lorazepam doesn't really seem to control the shaking that well.
Lyme causes psychiatric problems, no question, but I have no way of knowing if I'm still infected or not. Antibody tests don't mean anything, since they only measure exposure, not ongoing infection.
I'm attracted to Lamictal because my grandfather did well on Lithium.
Anyway, sorry for this impressionistic post; I'm just feeling kind of overwhelmed right now. I want a silver bullet, dammit.
Posted by ed_uk on December 19, 2004, at 14:05:08
In reply to Re: Lyme disease » ed_uk, posted by Phillipa on December 19, 2004, at 11:06:01
Hi,
>So, they don't favor Biaxin over there?
It was actually an American textbook! It didn't mention clarithromycin but an English book that I've got suggests azithromycin (which is similar). The textbook is a few years out of date.
Of the various tetracyclines, doxycycline is particularly notorious for causing sunburn. Perhaps you would benefit from long term high-dose oral amoxicillin.
Apparantly, depression is common in Lyme disease.... 'the majority of patients experienced psychiatric problems in the acute phase of disease as well as in the late phase--3, 6 months after the onset of the disease. The most common psychiatric manifestations were depressive disorders--episodes of depression or organic mood disorders.' Other psych disorders have been attributed to Lyme disease including cognitive impairment, anxiety disorders, psychotic disorders and eating disorders.
>you are such a wealth of knowledge. I wish you were a Md in USA! You would be a millionaire!
You are much too kind :-) I don't know very much about Lyme disease at all! Anyway, there is no way that I could cope with being a doctor.
Regards,
Ed.
Posted by Cole_B on December 19, 2004, at 14:33:09
In reply to Re: Lyme disease... to Phillipa, posted by ed_uk on December 19, 2004, at 14:05:08
> >So, they don't favor Biaxin over there?
> It was actually an American textbook! It didn't mention clarithromycin but an English book that I've got suggests azithromycin (which is similar). The textbook is a few years out of date.Both azithromycin and clarithromycin have excellent activity against the Lyme bug in a petri dish, but they perform no better than doxy in clinical trials. A possible reason is that neither has good penetration into the nervous system. If you have CNS Lyme, it is unlikely that the macrolides or azelides will cure you. (Hate to be negative, but if you've been infected a long time, it is much harder to be cured, period.)
Posted by Phillipa on December 19, 2004, at 16:07:38
In reply to Depression - Night and Day, posted by Cole_B on December 19, 2004, at 14:33:09
When I see the infection control Md he runs a Western Blot Reflex, Lyme PCR, Borrelia Burgdorferi, Lyme AB, and complete blood profile, as well as ANA. The ANA is very elevated when the disease is very active. I've had Cerebral Spinal Fluid tested, and Brain MRI. I don't think they can detect where damage is done though. Do you know of a way? It sounds like you have done a lot of research or seen a lot of docs. I was first dx'd 7 years ago, but since I'm originally from Ct where it is extremely widespread I really don't know how long it has been. I never had a Bullseye rash that I'm aware of. Do you know of meds for anxiety/depression that are supposed to help? Oh, my spinal fluid was clear, and MRI then was negative. Just the lab work was positive. Thanks, Phillipa
Posted by Cole_B on December 19, 2004, at 16:45:53
In reply to Re: Depression - Night and Day » Cole_B, posted by Phillipa on December 19, 2004, at 16:07:38
> When I see the infection control Md he runs a Western Blot Reflex, Lyme PCR, Borrelia Burgdorferi, Lyme AB, and complete blood profile, as well as ANA. The ANA is very elevated when the disease is very active. I've had Cerebral Spinal Fluid tested, and Brain MRI. I don't think they can detect where damage is done though. Do you know of a way? It sounds like you have done a lot of research or seen a lot of docs. I was first dx'd 7 years ago, but since I'm originally from Ct where it is extremely widespread I really don't know how long it has been. I never had a Bullseye rash that I'm aware of. Do you know of meds for anxiety/depression that are supposed to help? Oh, my spinal fluid was clear, and MRI then was negative. Just the lab work was positive. Thanks, Phillipa
The Bb PCR could theoretically be useful if it comes up positive, since that would be a sign of continuing infection requiring antibiotic treatment. Unfortunately PCR is a very low yield test in Lyme disease, because there are so few organisms involved. It is quite possible to have ongoing infection and a negative PCR, simply because there were no bacteria in the sample drawn.
There is a lot of controversy in Lyme over whether ongoing symptoms after "appropriate" treatment is due to ongoing infection or post-infectious immune processes. It's probably different things in different people; it is a very complicated infection.
As for psych meds, it's pretty much the usual suspects for anxiety and depression; there don't seem to be any particular psych meds for Lyme per se.
You don't say where you are geographically now. One useful test to assess the brain is SPECT, which looks at blood perfusion in the brain. Lyme patients tend to have moderate global hypoperfusion, a sign of either vasculitis or mild encephalitis. Columbia University has a good SPECT machine and a number of physicians (neuros and psychs) who know Lyme pretty well. If you Google "Lyme" and "Columbia," you will likely get some helpful info. Also, do a search on "Brian Fallon."
But still, SPECT is a pretty crude measurement. I mean, a positive finding is significant, but it won't be useful for pinpointing exact brain damage in a way that is likely to influence your therapy. If you have anxiety and/or depression, they have to be treated as such.
Wish I could give you something more definitive. (Wish I could give myself something more definitive!)
This is the end of the thread.
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