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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 oneamradio on June 6, 2004, at 3:40:05
Hi Everyone.
I posted once a long time ago.
I've been suffering from depression for over five years now. I'm only 19.
And I'm starting to feel the way I did when I was at my lowest. When I actually contemplated suicide. The main thing retaining my sanity at all is the thought of my parents faces if they saw me...
When I was first diagnosed, I was put on Prozac and Trazodone, but those two clearly had no effect. I went through 3 different psychiatrists/therapists, and the 3rd one wanted to admit me to a mental institution. The only thing that kept me from going was "insurance problems." I have no idea if that is true or not. I don't think my parents wanted me to go. I didn't want to either. That was one of the scariest days of my life. I really don't think locking me up is going to make me feel better.
I've been on Effexor XR for over a year now... Been on 450mg/day for I believe 9 months now... First visit was 85mg, second was 150, third was 300, fourth was 450. I started in May 2003, went each month for a visit... I think that's about right. With each increase, I think I somehow psychologically tricked myself into thinking things were getting better and that I was happier. But each time something bad happened, I quickly descended into a downward spiral. And things would get bad. Fast.
I know that 450mg is a fairly high dosage. I've done my research. 225mg is the highest they did testing on, 375mg is the highest recommended... I think 450mg is the legal something-or-other?
I just find this all very discouraging... My next apppointment is June 17. Could anyone recommend what I should tell/ask my doc?
I just got finished crying so hard that I literally could not breathe through my nose, and I had trouble breathing through my mouth. I've tried so much. Exercising, new hobbies, talking to people (I can't really find anyone who seems to understand... Lots of people make it seem like depression is a choice but if that were the case--I would choose to be happy right now, unfortunately it's not that simple). Even though I HATE the idea of medication, I took that route again. And even though I am on a high dosage of the so-called "power" drug, I'm still finding myself getting occasionally as depressed as I was the summer after 8th grade.
It's getting harder to motivate myself out of this. I've been trying... I really want this to be over. I'm trying.
Can someone please help. Please. It would be very much appreciated. ANY advice is welcome.
Thanks for your time...
Posted by sooshi on June 6, 2004, at 7:43:11
In reply to Effexor XR user for a year + and still depressed, posted by oneamradio on June 6, 2004, at 3:40:05
Hi oneamradio,
I'm so sorry to hear you are having such a hard time...hang in there, because it does get better. It may take a lot of work, but it does get better.
Have you tried Cognitive Behavioral Therapy? It really helped me with the feelings/thoughts that my depression was never-ending and controlling my every waking thought. It helps me deal in the hear and now, and what power I have to handle current symptoms in the present moment, not the "failures" of the past.
What exactly is your diagnosis? Do you just have depression...no "high's" or mania/hypomania? I was diagnosed as Major Depressive for 18 years before finally understanding that I really had Bipolar II, and have since added a mood stabilizer to my Effexor, which has helped tremendously. Not saying that you might have BPII, just saying you might want to have your pdoc review your current symptoms to see if there are things that might have been missed or if there are any changes.
That IS a high dose of Effexor! I've taken 300mg for almost 5 years now, and my pdoc will NOT go up on it. He would always add something to it to help increase it's effectiveness...hasn't your pdoc tried this?
Just a few suggestions...I hope you find the answer you're looking for. Keep me posted and good luck,
Sooshi
Posted by Sad Panda on June 6, 2004, at 10:49:16
In reply to Effexor XR user for a year + and still depressed, posted by oneamradio on June 6, 2004, at 3:40:05
Hi oneamradio,
I would ask your doctor about a different drug, I take Effexor myself & like it, but 450mg is a little bit on the high side. I would consider an MAOI or a TCA depending on what your diagnosis is.
Cheers,
Panda.
Posted by Racer on June 6, 2004, at 14:19:13
In reply to Effexor XR user for a year + and still depressed, posted by oneamradio on June 6, 2004, at 3:40:05
I took Effexor with a similar problem. It helped a bit, but not nearly enough. Adding a low dose of Prozac was the answer for me. You might want to ask about adding another drug to augment its effectiveness.
Psychopharmacology is a little like Schliemann searching for Troy. They don't really know enough to make it a science yet, although they'll tell you it is. There are enough data, though, to help them make some good choices for most patients. Most of the drugs affect known neurotransmitter systems, so if one drug is helpful, they can use that knowledge to predict that another drug affecting the same systems is likely to be helpful, too. Similarly, if a specific drug doesn't help, a drug affecting another system might be a better candidate. Since Effexor affects (I think) norepinephrine and a bit of dopamine, adding an SSRI to target serotonin as well might make sense. Alternately, if the Effexor really isn't doing anything at all beyond the placebo effect, then switching entirely to an SSRI might make sense.
You've got a bit more than a week to go, so here's a bit of non-med advice for you: make yourself a little spreadsheet and make up a code for your moods. (Mine is a 1 to 5 depression scale, from mildly down at 1, to actively suicidal at 5.) Record your mood at set times during the day, with or without notations about meals, etc. Put in a column for notes about what's going on, or your activities. Before you go in to see the doctor, print that out (make a chart, if you can) and take it to him. A lot of times, someone suffering depression is so focussed on Right Now, we forget that yesterday might have been different. The mood chart can give a much better idea of any variations that have taken place for you.
I'm hardly the med expert, so I'll leave that to someone who actually knows something. What I can offer is my best wishes, and those you have.
Posted by King Vultan on June 7, 2004, at 8:14:23
In reply to Effexor XR user for a year + and still depressed, posted by oneamradio on June 6, 2004, at 3:40:05
There is a school of thought that people who suffer from long term severe depression may be helped more by drugs that focus on norepinephrine rather than serotonin. Effexor is a very effective AD that certainly has some effect on norepinephrine, especially at the dosage you are on, but its powerful blockade of serotonin reuptake still dominates the overall character of the drug. I think your non-response to Prozac, which basically only works on serotonin, is telling, and I would suggest considering a drug from another class. I am in complete agreement with Panda's suggestion of a TCA or MAOI.
Certain aspects of your story remind me of some of my own experiences, and I really do sympathize with you. Inspite of the frustrations you've suffered so far, you might want to consider that you are at least somewhat fortunate in that you have already obtained psychiatric care at a rather young age. I also suffered from depression in my teen years but was never treated for it, and this turned into severe anxiety in my 20's, and then an even more debilitating depression. I never saw a psychiatrist until I was 30, and by then, my life had suffered a great deal of damage. It's taken another 10 years and about 10 different meds to find something that works relatively well for me, which in my case is an MAOI (I also find TCAs to be somewhat effective). I used to abhor the idea of taking a med also, but that feeling has long since passed, since it's become abundantly clear that I can't get by without one. There is also much less of a stigma about taking antidepressants now than there was even ten years ago, with untold millions of people taking them, and my opinion is that most of them are not as depressed as you are.
Todd
Posted by oneamradio on June 7, 2004, at 19:04:20
In reply to Effexor XR user for a year + and still depressed, posted by oneamradio on June 6, 2004, at 3:40:05
Thanks to everyone who left me feedback. It means a lot.
I will definitely take your suggestions to my doc for my next visit. First, I'll tell him what's been going on and let him give me some input. Then, I'll go ahead and ask him about other kinds of meds and whatnot. I am determined to get through this.
You're right, it is fortunate that I have taken action at such a young age, but my thoughts on that are this: If I had not taken any previous action, I probably wouldn't be here today. I know that's really sad, but I have very little doubt that I would've gone to the utmost extreme... I saw my first psychiatrist when I was 14. I don't really remember what it was like except I filled out a questionaire, and then she put me on Prozac and Trazodone. When that wasn't working, my parents took me to a new doc who I'm pretty sure offered nothing useful. Then, the last doc... This was when I was on the brink of suicide. They wanted to lock me up. And that just blows my mind.
And here I am again, back at square one. But I'm trying, I really am. And there's got to be something out there for me. I guess I'm just not responding enough to the serotonin, I will ask about the other types you guys mentioned.
Again, thanks so much, and if you have any other feedback, I'll gladly accept it.
I'll be sure to update when I figure this all out.
This is the end of the thread.
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