![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Cupcake1985 on July 23, 2012, at 20:06:44
So after years of failed medication attempts and frustration with inadequate doctors, I've decided to take matters into my own hands. Throughout my weeks of intense research, I have found these Dr. Bob boards very helpful and interesting, and thought I might as well throw my problems out there and see if anyone has any much needed and welcomed advice. I'll try to keep this short, but my medical past is anything but...Thanks for anyone who has the patience to bear with me..
Here's the "basics":
-I'm a 27 year-old female, and my first recollections of depression started between the ages of 8 and 10
-By age 13 I had been hospitalized twice for attempted suicide
-That year I was wrongfully diagnosed with bipolar disorder, although I have never in my life experienced a manic episode, (kinda wish I could sometimes) and was treated with numerous SSRI's and a short but horrid experience with lithium
-That year a new doctor diagnosed me with MDD and continued trials of more SSRI's and talk-therapy. We stopped when I received mild relief from Effexor 225 mg
-At age 16 I was diagnosed with metastatic melanoma and went through chemo for about a month and a half, I could not tolerate the year of treatment that I was prescribed
-A few years ago, when looking into meds that would aid in inhibition of the sexual dysfunction I was experiencing, my Dr. added in Wellbutrin 150 mg. We played around with XL and SR with not too much help besides some much welcomed weight loss
-This past year, as my fatigue, amotivation, and sexual dysfunction has been more and more debilitating, I decided to go off all meds (Effexor=HELL) and see a naturopath to see if we could determine the factors of my fatigue and depression. Besides a lowered immune system most likely from the chemo/cancer and Ebstein Barr Virus which I've had for years, and low testosterone, there was really nothing too incredibly wrong with me. I went on anti-virals for the EBV, did HRT for the testosterone, and several treatments to help with immune function
-My depression was rapidly worsening as months passed on no meds, after having been on high dose Effexor for 10+ years. We tried 5-HTP, desipramine, sertraline, buspirone, yohimbine, exercise, and a gluten free diet/liver detox with little to no noticeable benefit
-I asked if I could try stimulants to see if it would help with fatigue. I tried 100-200mg of provigil, 10-40 mg ritalin, and am currently on 20 mg adderall XR. I can still sleep 16 hours/day.
-I have never had an orgasm, nor ever been close to having one. I was hoping to experience one before I hit menopause :)So, out of desperation a couple months ago, I went back on Effexor XR 75 mg just for the time being while I do research. Just looking for any advice to help with fatigue/amotivation/depression that won't cause weight gain, sedation, or sexual dysfunction. I'm pretty sure I'm atypical depressive, and the only meds i have not yet tried are MAOI's.
Thanks for those who read this novel, and for any advice or info you can give!
Posted by Emily Elizabeth on July 23, 2012, at 20:26:13
In reply to Recommendations for an Atypical Depressive, posted by Cupcake1985 on July 23, 2012, at 20:06:44
Have you tried Abilify? It made a huge difference for me. It is much less likely to cause weight gain than other AAP's.
Best,
EE
Posted by pedr on July 23, 2012, at 21:37:32
In reply to Re: Recommendations for an Atypical Depressive, posted by Emily Elizabeth on July 23, 2012, at 20:26:13
I'll second abilify and also provigil. Both pooped out rather quickly for me but were fantastic whilst they lasted. Nardil did help me a lot but added 30 lbs and made me highly somnolent.
Pedr.
Posted by Phillipa on July 24, 2012, at 0:01:58
In reply to Re: Recommendations for an Atypical Depressive » Emily Elizabeth, posted by pedr on July 23, 2012, at 21:37:32
Also hate to bring up the melanoma you had but have you seen the tx doc for a follow up to make sure no recurrences through the body. Did they biopsy lymph nodes at the time? Just trying to be through. You mention menopause are you close to this in age now as years don't seem to match that age? Sorry if seems asking to many personal questions. Phillipa
Posted by jedi on July 24, 2012, at 2:45:29
In reply to Recommendations for an Atypical Depressive, posted by Cupcake1985 on July 23, 2012, at 20:06:44
I've been on Nardil for most of 14 years and it is the only medication out of 45+ combinations that has worked for my atypical depression. However, it can cause all of the side effects you mention. When depression is really serious and life threatening the side effects sometimes have to be lived with or medicated. IMHO MAOIs are the best medications for severe atypical depression. I had two failed trials of Parnate, but it is a MAOI that is not noted for sexual dysfunction, weight gain, or sedation. MAOIs did save my life when all other medications failed.
Good Luck,
Jedi
> So after years of failed medication attempts and frustration with inadequate doctors, I've decided to take matters into my own hands. Throughout my weeks of intense research, I have found these Dr. Bob boards very helpful and interesting, and thought I might as well throw my problems out there and see if anyone has any much needed and welcomed advice. I'll try to keep this short, but my medical past is anything but...Thanks for anyone who has the patience to bear with me..
>
> Here's the "basics":
> -I'm a 27 year-old female, and my first recollections of depression started between the ages of 8 and 10
> -By age 13 I had been hospitalized twice for attempted suicide
> -That year I was wrongfully diagnosed with bipolar disorder, although I have never in my life experienced a manic episode, (kinda wish I could sometimes) and was treated with numerous SSRI's and a short but horrid experience with lithium
> -That year a new doctor diagnosed me with MDD and continued trials of more SSRI's and talk-therapy. We stopped when I received mild relief from Effexor 225 mg
> -At age 16 I was diagnosed with metastatic melanoma and went through chemo for about a month and a half, I could not tolerate the year of treatment that I was prescribed
> -A few years ago, when looking into meds that would aid in inhibition of the sexual dysfunction I was experiencing, my Dr. added in Wellbutrin 150 mg. We played around with XL and SR with not too much help besides some much welcomed weight loss
> -This past year, as my fatigue, amotivation, and sexual dysfunction has been more and more debilitating, I decided to go off all meds (Effexor=HELL) and see a naturopath to see if we could determine the factors of my fatigue and depression. Besides a lowered immune system most likely from the chemo/cancer and Ebstein Barr Virus which I've had for years, and low testosterone, there was really nothing too incredibly wrong with me. I went on anti-virals for the EBV, did HRT for the testosterone, and several treatments to help with immune function
> -My depression was rapidly worsening as months passed on no meds, after having been on high dose Effexor for 10+ years. We tried 5-HTP, desipramine, sertraline, buspirone, yohimbine, exercise, and a gluten free diet/liver detox with little to no noticeable benefit
> -I asked if I could try stimulants to see if it would help with fatigue. I tried 100-200mg of provigil, 10-40 mg ritalin, and am currently on 20 mg adderall XR. I can still sleep 16 hours/day.
> -I have never had an orgasm, nor ever been close to having one. I was hoping to experience one before I hit menopause :)
>
> So, out of desperation a couple months ago, I went back on Effexor XR 75 mg just for the time being while I do research. Just looking for any advice to help with fatigue/amotivation/depression that won't cause weight gain, sedation, or sexual dysfunction. I'm pretty sure I'm atypical depressive, and the only meds i have not yet tried are MAOI's.
>
> Thanks for those who read this novel, and for any advice or info you can give!
Posted by Tomatheus on July 24, 2012, at 14:42:13
In reply to Recommendations for an Atypical Depressive, posted by Cupcake1985 on July 23, 2012, at 20:06:44
Hello Cupcake1985, and welcome to Psycho-Babble.
I just thought that I'd chime in and say that one thing that I've come across a lot as I've read the psychiatric literature is that the MAOIs tend to be more effective than the tricyclics at treating atypical depression. However, the side effects that you're looking to avoid (weight gain, sedation, and sexual dysfunction) can occur in patients taking MAOIs. From what I've read and experienced, it seems that Nardil is a much bigger offender than Parnate when it comes to weight gain and sexual dysfunction. And in my experience, sedation occurred with both Nardil and Parnate (although with Parnate, it only occurred when I took the American version of the medication). With Nardil, I remember feeling sleepy during my first few weeks on the medication before that particular side effect began to subside. Nardil was actually quite energizing for me when it worked, though. It's really the only medication that ever had a pronounced effect on my hypersomnia, reduced energy levels, psychomotor retardation, and anhedonia for more than a few days.
So, what do I advise that you do? I think that MAOIs would be worth taking a look at since they tend to be the treatment of choice for atypical depression, but I think that you also need to carefully evaluate the risks of MAOIs before determining whether to ask your doctor about one of those antidepressants. Another option you may want to consider is augmenting the Effexor that you're taking. Some here have already suggested Abilify, which is an option, but it's not the only option for the adjunctive treatment of depression. Other options include the antipsychotic Seroquel (although it's highly sedative), as well as the prescription "medical food" Deplin and the supplement SAM-e.
Unfortunately, finding a successful treatment or combination of treatments for a depressive disorder is a process of trial and error, and it seems that what works best for one patient doesn't necessarily work the best for the next patient. I wish that I could tell you based on experience what medication might work best for your symptoms, but unfortunately, my treatment history consists of a lot of temporary responses, some of which have been more pronounced than others. I do hope that the posts here, including mine, could be of some help to you, and I wish you luck in getting your symptoms under control.
Tomatheus
Posted by jono_in_adelaide on July 24, 2012, at 19:51:55
In reply to Recommendations for an Atypical Depressive, posted by Cupcake1985 on July 23, 2012, at 20:06:44
Try nardil and parnate, you have nothing to lose and everything to gain.
Posted by novelagent on July 25, 2012, at 14:33:19
In reply to Recommendations for an Atypical Depressive, posted by Cupcake1985 on July 23, 2012, at 20:06:44
Unfortunately, there's no treatment for sexual dysfunction... urologists dismiss it (including mine) as something that will eventually go away after a few months. I think I've been off Effexor for 4 months, and I don't have much hope of ige3tting any sexual interest back. You're lucky, you're a girl. You can fake it and no one will know. I wouldn't mind it so much if I could just fake it, but with zero sexual interest, the viagra my urologist gave me is worthless.
However, you will thank me when you try out some Emsam and combine it with DLPA. I took DLPA and selegeline oral before emsam came out, from advice on this board, after many people on this board were having great results-- and my atypical depression that I had for a year and a half went away. I didn't notice it until 2 weeks after I started taking it everyday. I noticed one day I hadn't craved sleeping during the day for the past 2 weeks 2 weeks in.
I got Life Extension DLPA, and trhe dosage you can look up by doing a search for "selegeline (spelling?) + DLPA" on this site. It was in 2005 when the threads on this were big. Good luck! My professors caught me smiling (while I didn't realize it, must have been spacing out) the first day I took it, both at inapprorpiate times given what was said in class... your friends will notice you have improved before you do. If you have to, take 9mg if the lower doses don't work; an MAOI diet will be necessary at that dose.
Posted by novelagent on July 25, 2012, at 14:37:25
In reply to Re: Recommendations for an Atypical Depressive » Cupcake1985, posted by jedi on July 24, 2012, at 2:45:29
I don't see why one would taker Nardil when 9mg of Emsam, while it would still require an MAOI diet at that dose, seems to be a more modern option... it would still be an MAOI-A at 9mg, but I took 10mg selegeline oral (before emsam was in the US) and didn't go on a diet. But I wouldn't try that at home, and encoueage taking an MAOI diet at 9mg of Emsam.
> I've been on Nardil for most of 14 years and it is the only medication out of 45+ combinations that has worked for my atypical depression. However, it can cause all of the side effects you mention. When depression is really serious and life threatening the side effects sometimes have to be lived with or medicated. IMHO MAOIs are the best medications for severe atypical depression. I had two failed trials of Parnate, but it is a MAOI that is not noted for sexual dysfunction, weight gain, or sedation. MAOIs did save my life when all other medications failed.
> Good Luck,
> Jedi
>
>
> > So after years of failed medication attempts and frustration with inadequate doctors, I've decided to take matters into my own hands. Throughout my weeks of intense research, I have found these Dr. Bob boards very helpful and interesting, and thought I might as well throw my problems out there and see if anyone has any much needed and welcomed advice. I'll try to keep this short, but my medical past is anything but...Thanks for anyone who has the patience to bear with me..
> >
> > Here's the "basics":
> > -I'm a 27 year-old female, and my first recollections of depression started between the ages of 8 and 10
> > -By age 13 I had been hospitalized twice for attempted suicide
> > -That year I was wrongfully diagnosed with bipolar disorder, although I have never in my life experienced a manic episode, (kinda wish I could sometimes) and was treated with numerous SSRI's and a short but horrid experience with lithium
> > -That year a new doctor diagnosed me with MDD and continued trials of more SSRI's and talk-therapy. We stopped when I received mild relief from Effexor 225 mg
> > -At age 16 I was diagnosed with metastatic melanoma and went through chemo for about a month and a half, I could not tolerate the year of treatment that I was prescribed
> > -A few years ago, when looking into meds that would aid in inhibition of the sexual dysfunction I was experiencing, my Dr. added in Wellbutrin 150 mg. We played around with XL and SR with not too much help besides some much welcomed weight loss
> > -This past year, as my fatigue, amotivation, and sexual dysfunction has been more and more debilitating, I decided to go off all meds (Effexor=HELL) and see a naturopath to see if we could determine the factors of my fatigue and depression. Besides a lowered immune system most likely from the chemo/cancer and Ebstein Barr Virus which I've had for years, and low testosterone, there was really nothing too incredibly wrong with me. I went on anti-virals for the EBV, did HRT for the testosterone, and several treatments to help with immune function
> > -My depression was rapidly worsening as months passed on no meds, after having been on high dose Effexor for 10+ years. We tried 5-HTP, desipramine, sertraline, buspirone, yohimbine, exercise, and a gluten free diet/liver detox with little to no noticeable benefit
> > -I asked if I could try stimulants to see if it would help with fatigue. I tried 100-200mg of provigil, 10-40 mg ritalin, and am currently on 20 mg adderall XR. I can still sleep 16 hours/day.
> > -I have never had an orgasm, nor ever been close to having one. I was hoping to experience one before I hit menopause :)
> >
> > So, out of desperation a couple months ago, I went back on Effexor XR 75 mg just for the time being while I do research. Just looking for any advice to help with fatigue/amotivation/depression that won't cause weight gain, sedation, or sexual dysfunction. I'm pretty sure I'm atypical depressive, and the only meds i have not yet tried are MAOI's.
> >
> > Thanks for those who read this novel, and for any advice or info you can give!
>
>
Posted by jedi on July 25, 2012, at 17:29:31
In reply to Re: Recommendations for an Atypical Depressive » jedi, posted by novelagent on July 25, 2012, at 14:37:25
Have you ever taken Nardil? It is the "Bomb" for treatment resistant atypical depression. Read the history of Emsam on this board. Most of the people here are treatment resistant. Many have tried and very few have succeeded with Emsam. You can't say the same for Nardil. It is often the last resort and works when others don't. Just my humble opinion.
Be well,
Jedi
> I don't see why one would taker Nardil when 9mg of Emsam, while it would still require an MAOI diet at that dose, seems to be a more modern option... it would still be an MAOI-A at 9mg, but I took 10mg selegeline oral (before emsam was in the US) and didn't go on a diet. But I wouldn't try that at home, and encoueage taking an MAOI diet at 9mg of Emsam.
>
> > I've been on Nardil for most of 14 years and it is the only medication out of 45+ combinations that has worked for my atypical depression. However, it can cause all of the side effects you mention. When depression is really serious and life threatening the side effects sometimes have to be lived with or medicated. IMHO MAOIs are the best medications for severe atypical depression. I had two failed trials of Parnate, but it is a MAOI that is not noted for sexual dysfunction, weight gain, or sedation. MAOIs did save my life when all other medications failed.
> > Good Luck,
> > Jedi
> >
> >
> > > So after years of failed medication attempts and frustration with inadequate doctors, I've decided to take matters into my own hands. Throughout my weeks of intense research, I have found these Dr. Bob boards very helpful and interesting, and thought I might as well throw my problems out there and see if anyone has any much needed and welcomed advice. I'll try to keep this short, but my medical past is anything but...Thanks for anyone who has the patience to bear with me..
> > >
> > > Here's the "basics":
> > > -I'm a 27 year-old female, and my first recollections of depression started between the ages of 8 and 10
> > > -By age 13 I had been hospitalized twice for attempted suicide
> > > -That year I was wrongfully diagnosed with bipolar disorder, although I have never in my life experienced a manic episode, (kinda wish I could sometimes) and was treated with numerous SSRI's and a short but horrid experience with lithium
> > > -That year a new doctor diagnosed me with MDD and continued trials of more SSRI's and talk-therapy. We stopped when I received mild relief from Effexor 225 mg
> > > -At age 16 I was diagnosed with metastatic melanoma and went through chemo for about a month and a half, I could not tolerate the year of treatment that I was prescribed
> > > -A few years ago, when looking into meds that would aid in inhibition of the sexual dysfunction I was experiencing, my Dr. added in Wellbutrin 150 mg. We played around with XL and SR with not too much help besides some much welcomed weight loss
> > > -This past year, as my fatigue, amotivation, and sexual dysfunction has been more and more debilitating, I decided to go off all meds (Effexor=HELL) and see a naturopath to see if we could determine the factors of my fatigue and depression. Besides a lowered immune system most likely from the chemo/cancer and Ebstein Barr Virus which I've had for years, and low testosterone, there was really nothing too incredibly wrong with me. I went on anti-virals for the EBV, did HRT for the testosterone, and several treatments to help with immune function
> > > -My depression was rapidly worsening as months passed on no meds, after having been on high dose Effexor for 10+ years. We tried 5-HTP, desipramine, sertraline, buspirone, yohimbine, exercise, and a gluten free diet/liver detox with little to no noticeable benefit
> > > -I asked if I could try stimulants to see if it would help with fatigue. I tried 100-200mg of provigil, 10-40 mg ritalin, and am currently on 20 mg adderall XR. I can still sleep 16 hours/day.
> > > -I have never had an orgasm, nor ever been close to having one. I was hoping to experience one before I hit menopause :)
> > >
> > > So, out of desperation a couple months ago, I went back on Effexor XR 75 mg just for the time being while I do research. Just looking for any advice to help with fatigue/amotivation/depression that won't cause weight gain, sedation, or sexual dysfunction. I'm pretty sure I'm atypical depressive, and the only meds i have not yet tried are MAOI's.
> > >
> > > Thanks for those who read this novel, and for any advice or info you can give!
> >
> >
>
>
Posted by novelagent on July 26, 2012, at 13:27:15
In reply to Re: Recommendations for an Atypical Depressive » novelagent, posted by jedi on July 25, 2012, at 17:29:31
You should see the posts about emsam and DLPA as a combo--- boy, are those quite a few success stories, circa 2004/2005.... I tried antipsychotics, antidepressants, SNRIs, everything.... I was treatment resistant, had atypical depression, and trust me,selegiline + DLPA worked.
It's possible people who failed emsam were taking it at the MAOI-B dose, and not at the 9mg MAOI-A dose. That's an unfair comparison. Most wouldn;t be on the 9mg dose
I've never had to take Nardil-- oral selegiline put me in remission years ago, and I've been fine ever since. I took .selegiline for 6 months.
> Have you ever taken Nardil? It is the "Bomb" for treatment resistant atypical depression. Read the history of Emsam on this board. Most of the people here are treatment resistant. Many have tried and very few have succeeded with Emsam. You can't say the same for Nardil. It is often the last resort and works when others don't. Just my humble opinion.
> Be well,
> Jedi
>
>
> > I don't see why one would taker Nardil when 9mg of Emsam, while it would still require an MAOI diet at that dose, seems to be a more modern option... it would still be an MAOI-A at 9mg, but I took 10mg selegeline oral (before emsam was in the US) and didn't go on a diet. But I wouldn't try that at home, and encoueage taking an MAOI diet at 9mg of Emsam.
> >
> > > I've been on Nardil for most of 14 years and it is the only medication out of 45+ combinations that has worked for my atypical depression. However, it can cause all of the side effects you mention. When depression is really serious and life threatening the side effects sometimes have to be lived with or medicated. IMHO MAOIs are the best medications for severe atypical depression. I had two failed trials of Parnate, but it is a MAOI that is not noted for sexual dysfunction, weight gain, or sedation. MAOIs did save my life when all other medications failed.
> > > Good Luck,
> > > Jedi
> > >
> > >
> > > > So after years of failed medication attempts and frustration with inadequate doctors, I've decided to take matters into my own hands. Throughout my weeks of intense research, I have found these Dr. Bob boards very helpful and interesting, and thought I might as well throw my problems out there and see if anyone has any much needed and welcomed advice. I'll try to keep this short, but my medical past is anything but...Thanks for anyone who has the patience to bear with me..
> > > >
> > > > Here's the "basics":
> > > > -I'm a 27 year-old female, and my first recollections of depression started between the ages of 8 and 10
> > > > -By age 13 I had been hospitalized twice for attempted suicide
> > > > -That year I was wrongfully diagnosed with bipolar disorder, although I have never in my life experienced a manic episode, (kinda wish I could sometimes) and was treated with numerous SSRI's and a short but horrid experience with lithium
> > > > -That year a new doctor diagnosed me with MDD and continued trials of more SSRI's and talk-therapy. We stopped when I received mild relief from Effexor 225 mg
> > > > -At age 16 I was diagnosed with metastatic melanoma and went through chemo for about a month and a half, I could not tolerate the year of treatment that I was prescribed
> > > > -A few years ago, when looking into meds that would aid in inhibition of the sexual dysfunction I was experiencing, my Dr. added in Wellbutrin 150 mg. We played around with XL and SR with not too much help besides some much welcomed weight loss
> > > > -This past year, as my fatigue, amotivation, and sexual dysfunction has been more and more debilitating, I decided to go off all meds (Effexor=HELL) and see a naturopath to see if we could determine the factors of my fatigue and depression. Besides a lowered immune system most likely from the chemo/cancer and Ebstein Barr Virus which I've had for years, and low testosterone, there was really nothing too incredibly wrong with me. I went on anti-virals for the EBV, did HRT for the testosterone, and several treatments to help with immune function
> > > > -My depression was rapidly worsening as months passed on no meds, after having been on high dose Effexor for 10+ years. We tried 5-HTP, desipramine, sertraline, buspirone, yohimbine, exercise, and a gluten free diet/liver detox with little to no noticeable benefit
> > > > -I asked if I could try stimulants to see if it would help with fatigue. I tried 100-200mg of provigil, 10-40 mg ritalin, and am currently on 20 mg adderall XR. I can still sleep 16 hours/day.
> > > > -I have never had an orgasm, nor ever been close to having one. I was hoping to experience one before I hit menopause :)
> > > >
> > > > So, out of desperation a couple months ago, I went back on Effexor XR 75 mg just for the time being while I do research. Just looking for any advice to help with fatigue/amotivation/depression that won't cause weight gain, sedation, or sexual dysfunction. I'm pretty sure I'm atypical depressive, and the only meds i have not yet tried are MAOI's.
> > > >
> > > > Thanks for those who read this novel, and for any advice or info you can give!
> > >
> > >
> >
> >
>
>
Posted by avenarius on July 30, 2012, at 13:31:40
In reply to Recommendations for an Atypical Depressive, posted by Cupcake1985 on July 23, 2012, at 20:06:44
Selegiline was great for my atypical depression but sleep became impossible without ambien. And after a couple of months the ambien was less and less effective. I also started to feel like some sort of energetic zombie - i was active but had no emotions.
I don't know how anyone can take MAOIs considering the insomnia isues.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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