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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Amorphous on December 19, 2011, at 3:07:56
Hello,
I'm looking for insight into an issue regarding the treatment of my depression, preferably from somebody with knowledge of treatment-resistant depression and neuroscience. If you don't possess such knowledge but are aware of a suitable place I may ask, I would be greatful for such knowledge.
Summed briefly, I have chronic, treatment-resistant major depression and generalised anxiety which has proven resistant against every form of treatment attempted including SSRIs, SNRIs, Tetracyclics, mood stabilisers, antipsychotics, electroconvulsive therapy and psychiatric therapy including CBT. Potentially, its severity is also increasing as I age.
While SSRI/SNRI medication has given me modest improvement, it has never improved my mood beyond dysthymia and after eight to ten months of use loses its effectiveness requiring me to switch to another medication.
The most significant issue lies with several anomalously positive improvements from a handful of medications when co-administered with the SSRI/SNRI (Lithium, Aripiprazole, Mianserin). After approximately a week of commencing the initial low dosage I experience a radical and profound improvement in my mood. I become brighter, livelier, socially engaged, cognitively capable and generally interested in life. Furthermore I become more physically capable, exercising well beyond my usual limited degree of strength and fatigue in addition to experiencing the endorphin rush that I had until this point, considered a myth. The great tragedy is that this state lasts only several days then rapidly ceases with no further recurrence regardless of increases to dosage or time.
I am now left with worsening depression and anxiety that alternates between dysthymia and severe anxious depression with suicide idealation becoming more common. At this point I fear that the only remaining possibility of successful treatment could be experimental and expensive deep brain stimulation.
Does anybody have any insight or suggestions regarding this profound but brief improvement I experience with certain medications and its similarly rapid cessation? Also, would this likely be detrimental to the success of DBS? My fear is that the mechanism by which my brain so rapidly adapts to medication could also mitigate any improvement gained through other therapies. I have been unable to gain any insight locally so am reaching out over the Internet for answers.
Thank you for your time.
Posted by SLS on December 19, 2011, at 8:06:37
In reply to Seeking insight on treatment resistant depression, posted by Amorphous on December 19, 2011, at 3:07:56
I have no answers for you because I haven't found answers for me. Your case profile greatly resembles mine. The only period of remission that I experienced was brought about by taking a combination of Parnate and desipramine. If you haven't tried a TCA + MAOI combination, you might want to take a serious look at it. My brief responses to antidepressants last for no longer than three days, after which no improvement can be recaptured regardless of dosage or time. I have the same concerns regarding DBS. I worry that my brain will quickly compensate for and relapse during treatment. Some people report responding to an opioid known as buprenorphine (Subutex). It is used for pain and to combat heroin addiction. It is an interesting drug. I am interested in the ketamine studies that demonstrate a very rapid antidepressant response, often within hours. It has been described as a kick-start that will make other antidepressants work better.
- Scott
Posted by Amorphous on December 19, 2011, at 11:02:03
In reply to Re: Seeking insight on treatment resistant depression » Amorphous, posted by SLS on December 19, 2011, at 8:06:37
Thank you for your response Scott, I'll look into those options. I was aware of Ketamine's experimental use but not of its potential to effect response to other antidepressants. Do you have any links to relevant articles? I'd like to read more. Your mention of the Opiate option made me think of my lack of response to endorphins. I wonder if there is any useful diagnostic information in that?
A related question: Do you have any sleep-related problems? I experience the symptoms of a combination of Narcolepsy and Delayed Sleep Phase Disorder. The specialist is still trying to work out exactly what the issue is. It may be a co-contributor to my the depression or purely coincidental.
Posted by SLS on December 20, 2011, at 13:41:48
In reply to Re: Seeking insight on treatment resistant depression, posted by Amorphous on December 19, 2011, at 11:02:03
> Thank you for your response Scott, I'll look into those options. I was aware of Ketamine's experimental use but not of its potential to effect response to other antidepressants. Do you have any links to relevant articles?
I can't find anything. Perhaps I am mistaken.
> A related question: Do you have any sleep-related problems?
Not really. I sometimes wake up too early when taking Nardil.
> I experience the symptoms of a combination of Narcolepsy and Delayed Sleep Phase Disorder.
Phase-delaying sleep can induce depression. Phase-advance can produce an antidepressant response. I don't know how this might be relevant to your sleep disorder.
- Scott
Posted by LostBoyinNCReturns on March 17, 2012, at 9:55:05
In reply to Seeking insight on treatment resistant depression, posted by Amorphous on December 19, 2011, at 3:07:56
How was your response to ECT? They used to say ECT always cured depression no matter what. Now they (ECT experts) are claiming ECT is an extremely effective short term depression treatment.
Did you have monthly followup ECTs following that initial 10 to 12 round of ECTs? If not, that is probably why it did not work. I have read and been told by psychiatrists I was using you have to have monthly followup ECTs for it to hold. Indefinitely, for life basically.
Also, have you been to a sleep medicine physician? Have you been thoroughly screened for sleep apnea, even mild sleep apnea? Severe depression can be greatly helped by treating even mild apnea. Also, there are other sleep disorders to be screened out, RLS, PLMD.
I am a former TRD who actually got out of TRD via CPAP therapy. I was TRD from late 97 to mid 2008. I was put on CPAP in late summer 2007 and it took some time to adjust to CPAP and afterwards, I began feeling like I wanted to exercise more like I used to. I began exercising, lost some weight all while continuing to use CPAP gear and taking a mere 50 mg Zoloft. I found CPAP made my meds work better, I dont have a clue what the mechanism is all I know is my meds are more effective when I use CPAP.
Also, many "depression" symptoms I use to think were mental or depression went away completely to nearly completely from CPAP use.
I would think treatment of even mild sleep apnea, combined with a round of ECT followed by monthly maintenance ECTs, to be a very potent and effective treatment for TRD.
Eric
Posted by DyseaseModel on April 8, 2012, at 23:29:35
In reply to Seeking insight on treatment resistant depression, posted by Amorphous on December 19, 2011, at 3:07:56
What if treatment resistant depression was actually not solvable in the brain, where symptoms appear to be depression, but result from other chronic endocrine/stress response disease?
Also, I rarely see any info on alternatives to the Standard American Diet, or food allergies... What about ameliorating our environments, and tailoring our worlds by addressing our negative circumstances?
I'm not implying it's situational-- I'm suggesting that there's more to depression (whatever the source) than neurotransmitters, and that we should buffer ourselves on all fronts. Good diet, a less stressful workplace, better relationships, exercise, traditional chinese medicine, meditation, etc...
Ideally, a longer acting AD would provide the bootstrapping needed to allow the time for CBT to help you create new associative neural habits.
Think about the HPA axis, ACTH, CRH, cortisol, oxytocin, vassopressin, testosterone, thyroid function. The Disease Model...
This is the end of the thread.
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