![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Janet on January 16, 2000, at 16:10:47
My mother had dysthymia. She had 7 children, 6 of whom suffer from some kind of mental disorder e.g panic attacks, bullimia, depression. I've had SAD bulimia and I suffer from dysthymia. I've tried all the medications except MAOI and none have worked. My main symptom is tierdness. I have no energy: people think that I'm lazy.I have two daughters and I worry that they will inherit the same disorder.When they were born I felt strangely detached and Iwas never abie to talk to them like other Mums. For years I had been trying to find out why I was so tierd. I have been to so many doctors and had so many diagnoses.When I found out I had dysthymia and that it could be cured I was so happy but after 18 mos. of treament with no results I feel down because I feel I'm condemned to lead this useless life forever. Nothing has gone well for me,jobs, marriage and now I feel that I'm doing a bad job of raising my daughters. Has anyone out there actually been cured of dysthymia? Jan
Posted by Noa on January 16, 2000, at 17:14:46
In reply to Dysthymia, posted by Janet on January 16, 2000, at 16:10:47
Cured? I think it is a tricky concept.
I understand your discouragement. I have been so discouraged myself. I have "double depression" which is dysthymia with cycling episodes of major depression on top of the dysthymia.
I think it is possible to treat the dysthymia sufficiently. But it takes finding the right combo of medications, and it takes some work in therapy to try to figure out how you want to live your life. And it takes support from people around you.
All of these things take time and effort and it can be discouraging. I am now trying to dispose of the idea of being "cured" because it has only led to feeling more disappointed when the depression returns. I am trying to just stabilize myself, to get control over the cycling major episodes. When I used to believe/hope that I had "put my depression behind me forever", it made me vulnerable to feelings of anxiety that depression might return. Now I am trying to accept that I live with depression and it is not a failure on my part if it comes back.
Maybe if you list what meds you have been on, what combinations, what doses, any negative or positive effects, people here will help you figure out a next step.
BTW, have you considered that you might have something else, like Epstein-Barr virus, Chronic Fatigue Syndrome, or a sleep disorder?
Posted by jd on January 16, 2000, at 18:42:33
In reply to Dysthymia, posted by Janet on January 16, 2000, at 16:10:47
Hello Janet,
The kind of history and symptoms you mention suggest that MAOI medications may indeed be worth trying. As you might know, MAOIs are often very successful with people who have had lifelong mood, energy, and/or eating problems that don't respond well to other medications. What is more, the family symptoms you mention (depression with panic attacks, bulimia, etc.) are part of a symptom "cluster" that generally responds well to MAOIs.
You should perhaps discuss all this with a well-informed psychopharmacologist... You'll note that there's a lot on this site about the various MAOI medications and their trade-offs (especially the initally scary dietary restrictions, which are apparently not as bad as has often been suggested). In general, Parnate has a reputation for being the most "activating" and the least likely to cause weight gain. Nardil probably has the best reputation for anxiety, panic attacks, and bulimia, but can cause significant weight gain in some people. (Marplan has a reputation for being somewhere "between" Nardil and Parnate.) Finally, there's also selegiline (Deprenyl), a related MAO drug which usually doesn't require eating restrictions when treating depression, but this may be effective in a smaller range of patients. Selegiline may be worth trying if you haven't tried an antidepressant that works on the neurotransmitter called dopamine (such as Wellbutrin)--the chronic tiredness suggests that this may at least be a piece of the puzzle, though some of the other symptoms you mention suggest that a full MAOI like Parnate or Nardil might be the better choice. In any event, I certainly wouldn't feel like you've "tried everything" until you've tried at least two MAOIs: they are many people's "last resort" and often have very encouraging results. (So much so that I'm even considering trying one myself for much the same reasons!)
Good luck to you,
jd
> My mother had dysthymia. She had 7 children, 6 of whom suffer from some kind of mental disorder e.g panic attacks, bullimia, depression. I've had SAD bulimia and I suffer from dysthymia. I've tried all the medications except MAOI and none have worked. My main symptom is tierdness. I have no energy: people think that I'm lazy.I have two daughters and I worry that they will inherit the same disorder.When they were born I felt strangely detached and Iwas never abie to talk to them like other Mums. For years I had been trying to find out why I was so tierd. I have been to so many doctors and had so many diagnoses.When I found out I had dysthymia and that it could be cured I was so happy but after 18 mos. of treament with no results I feel down because I feel I'm condemned to lead this useless life forever. Nothing has gone well for me,jobs, marriage and now I feel that I'm doing a bad job of raising my daughters. Has anyone out there actually been cured of dysthymia? Jan
Posted by andrewb on January 16, 2000, at 21:55:39
In reply to Dysthymia, posted by Janet on January 16, 2000, at 16:10:47
Janet,
First of all let me say that you have my sympathies. As a fellow dythymic, I understand the frustrations that accompany this condition. Unlike many depressions, dysthymia does not go away. For many of us, we have had it since an early age, it is all we have known, it is part of our temperment, it is who we are. I believe this is why many dysthymics go undiagnosed, they have never known anything else and thus don’t think they have a disorder or that something can be done for them.
You however have a diagnosis and that is a start. And chances are, though you haven’t found it yet, there is medication out there that will help you. In fact it is estimated that 70% of dythymic patients show improvement with medication. A Dr. Akiskal has claimed even greater results, stating that only those with physical brain damage are truely treatment resistant. Listen to this somewhat typical statement of someone helped by antidepressants, “I thought I was a sad person, now I feel different, it is as if life is a rich experience I had never felt before.” Please note that the source of the preceding information was a book entitled, “Dysthymia and the Spectrum of Chronic Depressions” (H. S. Akiskal, editor). Though somewhat technical you may want to check it out, it is a good introduction to dysthymia and the treatment options.
You are probably thinking now that while its fine other dysthymics have been helped by medicines, you’ve already tried so many so what could help you. Let me say, without knowing what you’ve tried already, that there is probably a lot of strategies left to explore. For example, have you tried mood stabilizers. Dr. Akiskal has stated that up to 50% of patients diagnosed as having dysthymia are, in fact, suffering from a ‘soft bipolar’ disorder and would thus benifit from treatment with mood stabilizers. Another possibility, is the same treatments that have helped those with Chronic Fatigue Syndrome (CFS) may help you. It has been speculated that a significant number people with dysthymia also have CFS.
One mistake doctors often make is to treat dysthymics like other depressives. They are different. For example it has been noted that those with dysthymia tend to repsond more slowly to antidepressants than those with major depression and that they often need high doses to achieve full recovery. Also, it is understandable for doctors to apply the most common treatments for depression, a variety of Selective Seretonin Reuptake Inhibitors (SSRIs) such as Prozac, for dysthymics. But, again, dysthymics are different. In fact, whereas platelet serotonin levels are reduced in people who are depressed or under great stress, they are actually increased in dysthymics.
I’m a perfect example of a dysthymic who wasn’t helped by the standard medications for depression. I was first given Sezone, which basically increases seretonin. It didn’t help my mood at all. It only made me feel more lethargic and foggy headed. The doctor then increased my dose, that only made things worse. I was like a zombie. Then he had me try Wellbutrin. (Wellbutrin is perhaps the most commonly prescribed antidepressant in the US that is not an SSRI.) Wellbutrin did not help my mood either and I had to discontinue it after 2 months because of increasing side effects like headaches. I found something that really worked for me, however, when I started taking the antidepressant amisulpride that my doctor prescribed from overseas. Amisulpride works in a novel way, it doesn’t effect seretonin at all, rather it works on another neurotransmitter, dopamine. Specifically, it increases the dopamine in the synaptic cleft of the D2-D3 receptors in the limbic system and to a lesser extent the striatum. What it did for me was improve my mood, concentration, energy and sense of pleasure while decreasing my social anxieties. (For more information on amisulpride and ordering it you can email me at andrewb@seanet.com.) After about 4 months though some of my symptoms returned, I again felt tired and unmotivated. So just recently I have started taking reboxetine, Reboxetine increases the amount of yet another neurotransmitter in the brain, norepinephrine, the brain’s version of adreniline. Its too early to tell what the full effect of reboxetine will be on me, but already it has provided me with a great increase in energy and I am more motivated. There have been almost no side effects. I feel very lucky to have found amisulpride and reboxetine, they have made such a difference in my life. It wasn’t easy though. For your sake and your daughters’ sakes, be willing to turn over quite a few stones before you find what helps you.
One final piece of advice. If you aren’t already doing it , supplement your diet with a qualtiy multi-vitamin, mineral and antioxidant formula. Shortages of magnesium, iron, and the B vitamins have been associated fatigue.Best Wishes,
Andrew
Posted by S. Suggs on January 17, 2000, at 5:43:14
In reply to Dysthymia, posted by Janet on January 16, 2000, at 16:10:50
Hello Janet: I myself have dysthymia. Had it for years before I was diagnosed. Tried almost every antidepressant with partial effects. Also, I am ADD-H (without hyperactivity). People can perceive you as being lazy, too bad, for them in this case perception is reality.
I finally ended up on Parnate. Taking 60 mg daily and have been on it for several months with outstanding results. As you might know it's a MAOI and getting a doc to write it could be difficult. I have energy, more outgoing, get more done, more positive, less anger (also take lithium 900 mg daily-started it to augment an antidepressant several years ago and it had some positive effects, that I knew were to the lithium that I decided to keep it). MAOI's are great for dysthymia (not the only class of meds), it's the dietary restrictions docs are cautious of. I'd talk to yours asap for other options. Blessings,
S. Suggs
Posted by Bruce on January 17, 2000, at 6:47:25
In reply to Re: Dysthymia, posted by andrewb on January 16, 2000, at 21:55:39
Andrew -
Did you experience any side effects from amisulpride?
Bruce
Posted by andrewb on January 17, 2000, at 10:15:37
In reply to Re: Dysthymia, posted by Bruce on January 17, 2000, at 6:47:25
>
> Did you experience any side effects from amisulpride?Bruce,
One possible side effect, benign prostate enlargement. I started having to get up one or two times a night to pee. I knew that amisulpride can increase prolactin levels. 5% to 10% of women can't take amisulpride due to prolactin related side effects (loss of menses, breast tenderness). Increased prolactin can cause prostate enlargement in men. I started taking saw palmetto, a supplement for prostate enlargement, and the need to urinate frequently went away. This is not a listed side effect for amisulpride but you know how that goes.
Posted by JohnL on January 17, 2000, at 15:39:59
In reply to Re: To Bruce, posted by andrewb on January 17, 2000, at 10:15:37
Hi Andrew. Hey, nice job on the dysthymia post. I found your post very informative and full of interesting things.
I tried Amisulpride once for a couple weeks. I liked it a lot. It had hardly any side effects. Dry mouth is all I remember. It energized me, made me socially comfortable. Overall significant global well-being. I'm thinking seriously of going back to it. The only reason I didn't stay with it was because it was hard to get....I couldn't get any doctor to write a precrip for it. Don't ask.
I was browsing through abstracts on hypericum one day when I came across this clinical study that determined St Johnswort strongly inhibits prolactin. Just a thought. You might want to look into that. With or without depression, St Johnswort might be a good companion with Amisulpride. Even if it didn't help depressive symptoms at all, it would counteract the prolactin increase of Amisulpride. But it might even help the dysthymia a bit. Just thought you might find prolactin inhibition by St Johnswort interesting. JohnL
Posted by zeke on January 17, 2000, at 16:32:48
In reply to Dysthymia, posted by Janet on January 16, 2000, at 16:10:47
>I've had SAD bulimia and I suffer from dysthymia.
By SAD you mean Seasonal Affective Disorder? Does your dysthymia become (more of) a problem in the winter?
If so, you should seek a specialist in Seasonal Affective Disorder and explore 'bright light therapy'. This is the treatment of choice for SAD. (well documented) Further side effects are less than with medication and often tend to go away.
There's lots of other good advice folks have posted medicine wise. The amisulpride info is curious to me -- it seems to be useful in both dysthymia and psychosis -- it agonizes dopamine but antagonizes dopamine receptors.
S.Suggs also makes a good point that I can personally vouch for about ADD and so called 'laziness'. I'll skip my usual plug for the stimulants except to say they are an option and safer than many other meds.
Your comments also make me think of postpartum depression. Estrogen may have some benefit to you.
Someone may have asked, but have any meds been effective for your siblings/mother? If so, that medication might work for you.
Posted by Scott L. Schofield on January 17, 2000, at 17:57:14
In reply to Re: To Andrew, posted by JohnL on January 17, 2000, at 15:39:59
> Hi Andrew. Hey, nice job on the dysthymia post.
Ditto - big time.
> I tried Amisulpride once for a couple weeks. I liked it a lot. It had hardly any side effects. Dry mouth is all I remember. It energized me, made me socially comfortable. Overall significant global well-being. I'm thinking seriously of going back to it. The only reason I didn't stay with it was because it was hard to get....I couldn't get any doctor to write a precrip for it. Don't ask.I have become very excited over the past few weeks reading posts regarding amisulpiride. I didn't even know it existed! While reading this thread, I can feel my heart racing with excitement.
My doctor is aware of this drug, and I'm sure he would be receptive to giving it a try.How do we get it?
Long, long ago... there was this compound named sulpiride that at the time was being investigated as a neuroleptic for schizophrenia. I think it was the levorotatory isomer they were looking at. Anyway, although there was little talk about it having antidepressant properties, its selectivity for presynaptic autoreceptors (which ones?) caught my eye. I have heard that sulpiride is available in Canada, but I haven't followed up on this.
Thanks for any information or suggestions.
(heart beginning to slow down)- Scott
Posted by jd on January 17, 2000, at 18:54:54
In reply to Re: Dysthymia, posted by jd on January 16, 2000, at 18:42:33
Janet,
Just a p.s. to my above post--I'm assuming you've had a full battery of medical tests including thyroid function, right?The thread of responses about new dopamine-acting meds like amisulpride is quite interesting--it's related to why I mentioned wellbutrin and selegiline to you, though amisulpride certianly looks very promising for dysthymia in particular. In the absence of unusual medical findings, my first hunch would still probably be to consider a trial of a full MAOI, though.
-jd
Posted by Janet on January 17, 2000, at 20:16:47
In reply to Re: Dysthymia, posted by S. Suggs on January 17, 2000, at 5:43:14
> Hello Janet: I myself have dysthymia. Had it for years before I was diagnosed. Tried almost every antidepressant with partial effects. Also, I am ADD-H (without hyperactivity). People can perceive you as being lazy, too bad, for them in this case perception is reality.
>
> I finally ended up on Parnate. Taking 60 mg daily and have been on it for several months with outstanding results. As you might know it's a MAOI and getting a doc to write it could be difficult. I have energy, more outgoing, get more done, more positive, less anger (also take lithium 900 mg daily-started it to augment an antidepressant several years ago and it had some positive effects, that I knew were to the lithium that I decided to keep it). MAOI's are great for dysthymia (not the only class of meds), it's the dietary restrictions docs are cautious of. I'd talk to yours asap for other options. Blessings,
>
> S. SuggsDear S Suggs,thanks for the encouragement, your note made me feel better Jan
Posted by Janet on January 17, 2000, at 21:03:20
In reply to Re: to Janet--thyroid, other tests?, posted by jd on January 17, 2000, at 18:54:54
> Janet,
> Just a p.s. to my above post--I'm assuming you've had a full battery of medical tests including thyroid function, right?
>
> The thread of responses about new dopamine-acting meds like amisulpride is quite interesting--it's related to why I mentioned wellbutrin and selegiline to you, though amisulpride certianly looks very promising for dysthymia in particular. In the absence of unusual medical findings, my first hunch would still probably be to consider a trial of a full MAOI, though.
>
> -jd
Thanks everyone for the advice.You are all so generous. I've never heard of amisulpride.I've taken a whole battery of tests and hormones are OK.I'm on wellbutrin but it has had no effect except to put on weight: more depression! I treated SAD by moving to Brazil! My sisters live in the UK and the only help they have gotten for their serious problems is of the 'pull yourself together variety' Doctors here in Brazil are much more uptodate although you have to pay.My own experience with
NHS doctors in England was not happy .They belong to the Stone Age and behave as though they are doing you a favour by seeing you , even though you do pay them indirectly through taxes.(Just wanted to get it off my chest)So my family is getting no help whatsoever.
Posted by andrewb on January 17, 2000, at 22:55:08
In reply to Re: To Andrew, posted by Scott L. Schofield on January 17, 2000, at 17:57:14
Scott,
If you email me at andrewb@seanet.com I will be glad to send you an information piece I’ve put together on amisulpride that is too long to include in a posting here. It will xxx provide information that should reassure your doctor that amisulpride is a safe and often effective treatment for dysthymia.
John,
Thank you for the info. on St Johns Wort. It could be very useful.
I’m so glad to hear that you had a good experience with amisulpride. I faxed Farmacia Rex in Argentina today asking if they offer amisulpride by mail. If they offer it without a prescription I will be sure to let the babble readers know.
Anyway, I saw your posting where you’re looking for a new doctor. Let me pass on my experience as far as that goes, you may find it useful. When I was checking out psychiatrists, looking for the right one, I’d arrange to talk briefly with them on the phone. One of the things that I would tell them on the phone was that I had tried an overseas antidepressant (amisulpride) with good results and I wanted to know that if I could provide them with information showing the medicine to be safe, would they consider prescribing it for me. This helped me locate a psychiatrist that was willing to prescribe amisulpride.Best Wishes,
Andrew
Posted by S. Suggs on January 18, 2000, at 6:13:07
In reply to Re: Dysthymia, posted by Janet on January 17, 2000, at 20:16:47
Janet: You are welcome. All of us posters, including yourself enjoy sharing our experiences to help those in need. Please keep us up to date on your progress. Many blessings to you!
S. Suggs
Posted by Seedwoman on January 22, 2000, at 18:44:03
In reply to Re: dysthymia, posted by Janet on January 17, 2000, at 21:03:20
Janet, I too am dysthymic,have been at least since adolescence, and have also had run-ins with "double depression". Dysthymics are indeed different from other depressives. I have had excellent results from a combination of meds, including at present Wellbutrin, Zoloft, Buspar, and Trazodone for sleep. However, I know I would not be where I am today without the several years I've had of psycotherapy with an excellent practitioner. The interactions of mood, neurochemistry, hormones, and thought are just so complex; everyone responds differently to various therapies. I just want to send you some encouragement, having myself emerged from a lifelong fog that is probably both "innate" in some way and also brought forth by stress in childhood and after...hang in there. the meds are important for me, which is something I have to relearn from time to time--my psychological health is excellent, better than ever, and yet my mood sometimes suffers no matter how well things are going, either due to stress, or hormones, or meds losing their effectiveness. "cure" is a bit pat for such complex transformations, and the depression remains latent. still, I've never been happier. hang in there. keep trying different meds; find yourself a psychiatrist whom you trust and who seems to know what he's doing with med combos; and consider psychotherapy if you think it would help (having had a depressed parent probably means that exploring some personal issues might give insight and help with the healing process).
best of luck to you.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.