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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on December 12, 2008, at 7:47:32
In reply to Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 12, 2008, at 1:42:34
You are one of many.
Have you ever tried combining an MAOI with a tricyclic and adding a mood-stabilizer to that?
- Scott
Posted by CaptainAmerica1967 on December 12, 2008, at 8:47:33
In reply to Re: Treatment Resistant (Refractory) Depression, posted by SLS on December 12, 2008, at 7:47:32
Yes,
Regards,
Jeff
Posted by SLS on December 12, 2008, at 9:22:31
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 12, 2008, at 8:47:33
You are apprised of the most current therapies as well as the old ones. In your situation, I would continue to ask, "What haven't I tried yet?" There is always something. Of course, it sometimes takes a little imagination. You couldn't possibly have tried every permutation of combination therapies using the drugs that are currently available. In that, I hope you find optimism.
For bipolar depression, I currently take:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
- Scott
Posted by CaptainAmerica1967 on December 12, 2008, at 9:49:40
In reply to Re: Treatment Resistant (Refractory) Depression, posted by SLS on December 12, 2008, at 9:22:31
Thanks,
I have unipolar with anxiety.
Take Parnate/Nortriptyline and have taken LiOr.
Tried Lamictal in the past while on Nardil and had no effect on me.
Tried Abilify with Nardil and got so depressed I that I was hospitalized and couldn't get out of bed. Abilify was depressogenic for me.
Posted by SLS on December 12, 2008, at 10:01:56
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 12, 2008, at 9:49:40
One simple trick I have used is to create a list of the drugs that produced even the slightest improvement, whether it be a brief robust improvement or a long term partial improvement. I then review the list and pick out drugs with different "mechanisms of action", and combine them, or drugs similar to them.
- Scott
Posted by CaptainAmerica1967 on December 12, 2008, at 10:28:04
In reply to Re: Treatment Resistant (Refractory) Depression, posted by SLS on December 12, 2008, at 10:01:56
Sounds like a good flow chart to use.
For me, it's always been an MAOI A, vigorous physical exercise (but at times have been to fatigue to work out...have used Rx testosterone gel once with a little benefit on fatigue), Sleep Deprivation (can become a little hypomanic but I'd rather be a little hypomanic compared to the vegetative state of sleeping all the time...have atypical depression) and Cold Water Therapy.
Jeff
Posted by SLS on December 12, 2008, at 11:24:18
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 12, 2008, at 10:28:04
You're a real smart guy, and it does sound to me that your persistence will one day pay off. In the interim, this is a good place to share and find support. Once in a great while, someone actually comes up with something brilliant. :-)
I hope you remain here for awhile. You have much to offer the community.
MAO-A is the way to go. I wish clorgyline were still around.
- Scott
Posted by Phillipa on December 12, 2008, at 11:34:21
In reply to Re: Treatment Resistant (Refractory) Depression, posted by SLS on December 12, 2008, at 11:24:18
Besides being smart you're very brave and very persistant I do envy that characteristic in you. I have a hard time imagining all you have tried and been through. And to work and go to school? Amazing. It's almost scarey to read what you've been through and still find hope. That quote on if you lose your health you have nothing or one similar is one my Mother used as she dies when I was l7. All I can do is wish you the very best as I have no experience in any of the advanced proceedures you've tried. Where do you get your persistance? Love Phllipa
Posted by CaptainAmerica1967 on December 12, 2008, at 13:43:59
In reply to Re: Treatment Resistant (Refractory) Depression, posted by SLS on December 12, 2008, at 11:24:18
Sounds like you know your material as well.
As far as Clorgiline, I'm not really familiar with it, but I believe I remember in my pharmacology class that it was also used to treat hypertension at one time or maybe I was thinking of pargyline.
David Pearce, owner of biopsychiatry.com, the good drug guide and other websites (HEDWEB and BTLC) that focus on ending all human, animal and plant suffering (he's a lactovegetarian like I am and suffers from depression) is a good person to chat with as well. I share his vision on ending suffering, but also the spiritual aspect of life and afterlife or NDE's (near death experiences, www.near-death.com, owner's name is Kevin Williams and he suffers from intractable bipolor depression) and what individuals who've had NDE come back to tell us about the true meaning of life (learning to love and help others) and that we choose our life prior to coming to Earth and that suffering allows for the growth of our souls/spirits...gets really deep.
Thanks for the welcome to PsychoBabble. I know we are not alone and as bad as "we" think we may have it, there are others who have it worse.
Regards,
Jeff
Posted by CaptainAmerica1967 on December 12, 2008, at 14:31:42
In reply to Re: Treatment Resistant (Refractory) Depression, posted by Phillipa on December 12, 2008, at 11:34:21
I wanted to ask whether you had problems prior to your Mother's death (sorry to hear..I guess she shared my idea, quote regarding one's health is the ultimate life possession) or whether the stress of the loss had tramadic effects on you?
I obviously believe in heredity, but also believe that tramadic stress in early childhood while the brain is still growing and maturing can have detrimental effects on mood later in life.
I know the vision of my Dad falling down and literally dying in front of me with his eyes wide open in our living when I was 5y/o really "stuck" in mind and memories as well as my Mom's decapitation and brain protrusion that I saw after I came to in the car accident we were in.
Where do I get my persistance? I think it's partially hereditary, but also a learned social behavior I picked up from both my parents.
I think lyrics to the 70's song "Everything I Own" by David Gates (Bread) in which I've dedicated to my parent for the love they provided and instilled in me best describes where I get my persistance. David Gates wrote, sang and dedicated this song in memory of his father.
Song lyrics-
Everything I Own Lyrics by Bread (David Gates)
You sheltered me from harm.
Kept me warm, kept me warm
You gave my life to me
Set me free, set me free
The finest years I ever knew
Were all the years I had with youI would give anything I own,
Give up me life, my heart, my home.
I would give everything I own,
Just to have you back again.You taught me how to love,
What its of, what its of.
You never said too much,
But still you showed the way,
And I knew from watching you.
Nobody else could ever know
The part of me that cant let go.I would give anything I own,
Give up me life, my heart, my home.
I would give everything I own
Just to have you back again.Is there someone you know,
Youre loving them so,
But taking them all for granted.
You may lose them one day,
Someone takes them away,
And they dont hear the words you long to sayI would give anything I own,
Give up me life, my heart, my home.
I would give everything I own
Just to have you back again.-Thanks for the welcoming me to PsychoBabble and your inspiring word...right back to you as I wish you the best.
Regards,
Jeff
Posted by polarbear206 on December 12, 2008, at 16:57:46
In reply to Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 12, 2008, at 1:42:34
I think that this is probably more of a bipolar spectrum than unipolar/refractory depression. This started when you were young, you have atypical symptoms. Describe them. Hypersomnia, hyperphagia, leaden feeling in extremities? etc.. sleep deprivation can cause you hypomania, or does it look like increased energy and goal directed? Hyperthymic personality? All of the multiple drugs and treatments that failed. If you trialed a mood stablizer with an AD, was the AD dose on the high or low side? Lamictal must be titrated slowly and good response is somewhere around 200mg. Have you ever worked with a psychopharmacologist? Do you keep any detailed log of sleep patterns, appetite, enegy levels, moods, etc.. Do you notice a seasonal pattern with your symptoms? Worse in the winter, etc.. Psycheducation.org has the best info out there for you to dig deep on the topic. I'm just throwing some random stuff out here. Tell me what ya think. Sorry, in a hurry.
Posted by Phillipa on December 12, 2008, at 20:19:31
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 12, 2008, at 14:31:42
Thanks Jeff but Mother was sick from the age of me being two and blamed for it. Didn't know any better so thought my childhood was normal. Never anyone home as always in hospital. Crashed with panic attacks age 24 benzos fine raised three kids all successful, married too many times, ran own aerobic business have to have my excercise daily, became a nurse and worked happily for lots of years then thyroid turned into hasimotos and haven't been the same since. Benzos only for over 37 years. Now with small amt of luvox. Love Phillipa
Posted by CaptainAmerica1967 on December 13, 2008, at 4:25:55
In reply to Re: Treatment Resistant (Refractory) Depression, posted by polarbear206 on December 12, 2008, at 16:57:46
Thanks for your response and input.
Sleep deprivation sometimes, but not always increases my energy levels.
Have been on Lithium, Tegretol, Lamictal, Xanex, Klonopin but they really didn't help.
Had some seizures while on trazodone and was diagnosed as having petit mal, but after going of trazodone I never had any more seizures.
Most of the psychiatrist I've seen are the head professor at universities and are well trained psychopharmacologists.
Sleep patterns are usually sleeping all of the time until the AD is boosted way up. No seasonal affects on my mood.
Thanks,
Jeff
Posted by CaptainAmerica1967 on December 13, 2008, at 5:05:06
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by Phillipa on December 12, 2008, at 20:19:31
So you were blamed on your mother's sickness? Your mother was always in the hospital? Father or any father figure while growing up?
I admire you for having raised three kids and having been married (isn't love great?) as I will probably never be married and really haven't had long term relationships because of the resistant depression...my thought is that I want to be the normal Jeff without the depression as several of my relationships failed because of the mood disorder.
It's only my brother and I remaining to carry on our last name and he is married and has a girl, but his wife hasn't been able to conceive again do to ovarian cysts.
So you're no longer working? What about the aerobic's business? I remember covering Hashimoto's thyroiditis in college. Are the meds for it helpful? I think George Bush senior suffers from Hashimoto's disease. Do they know the pathology behind the autoantiboides of Hashimoto's?
I was laid off from the drug company I was with two years ago after being with them for over ten years (really was cut I believe because my sales were dropping as I excelled for many years until the Nardil stopped working for me) and have't been able to get back into the sales since as the recruiters will not look at you if you're not currently in drug sales as it's so competitive anymore with the high salaries they pay...not licensed as a PA so that's out...have money saved up but not enough to live out my whole life with my mortgage and so forth.
Applied this past summer for medical social security disability and received it without any questions, but at $24K a year, I cannot live on it with my house payments. Hopefully I find something with my determination and as I mentioned have applied to some PhD programs, but I'm not really sure I can handle any more school with the depression.
best wishes,
Jeff
Posted by CaptainAmerica1967 on December 13, 2008, at 5:08:27
In reply to Re: Treatment Resistant (Refractory) Depression, posted by polarbear206 on December 12, 2008, at 16:57:46
Tried Abilify and severl other atypicals and become even more depressed.
Posted by polarbear206 on December 13, 2008, at 8:25:35
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 13, 2008, at 4:25:55
You wouldn't happen to live in NY city?
Dr. Ivan Goldberg who runs Depression Central website works with treatment resistant cases.
Posted by desolationrower on December 13, 2008, at 14:02:07
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 13, 2008, at 5:08:27
I don't see you mention stimulant augmentation with MAOIs - also with hypersomnia, MAOI + AMP + modafinil? Also NMDA antagonists as augmentations. For me the depression isn't the intractable issue so i've less personal experience to add, but welcome sounds like you havhe some interesting experiences to share
-d/r
Posted by CaptainAmerica1967 on December 13, 2008, at 14:24:43
In reply to Re: Treatment Resistant (Refractory) Depression, posted by polarbear206 on December 13, 2008, at 8:25:35
No, I live in Houston, TX (I grew up in upstate
New York around the Finger Lakes), but I know Dr. Goldberg and have gotten a consult with him via the email. He's one of the most knowledgeable people on TRD.His emails to me
" Hi . . .
The short answer is that the combinations most often used are:
phenelzine + amitriptyline and tranylcypromine + amitriptylineBest regards . . .
Ivan
Hi . . .
I find the combination of one of the MAOIs + (TCA or psychostimulant) to be a very powerful treatment for people with hard to treat depressions. The combination is even more effective when potentiated by lithium.
I am not convinced that TMS is a very useful treatment, but of course the people I get to see are the TMS failures. It looks as if deep brain stimulation, currently being researched at Columbia and Mass General is going to turn out to be a much better treatment.
Best regards . . .
Ivan
Thanks for suggesting Dr. Goldberg though and your thoughts.
I applied for the deep brain stimulation study in Dallas, TX, but because I had several seizures while on trazodone and at one time was diagnosed as having petit mal seizures (although they went away after going off trazodone and never had any more seizures and don't take any meds for it), I couldn't enter the study. I don't think the vagus nerve stimulator is effective nor were the 70 ECT's I had in 1985-1986.
Regards,
Jeff
Posted by CaptainAmerica1967 on December 13, 2008, at 14:39:28
In reply to Re: Treatment Resistant (Refractory) Depression, posted by desolationrower on December 13, 2008, at 14:02:07
Thanks,
Currently taking Parnate/Nortriptyline/Lithium Orotate.
Tried Lacmital, and Tegretol (had some petit mal seizure while on trazodone and receiving the 70 plus ECT's during 1986 which resulted in the mentioned car accident that killed my mother) in the past without big success.
Atypicals antipsyhcotic like Abilify sent me into even a more severe depression.
I tried Namenda (memantine) without noticing any affect or effect. I looked into getting into a Ketamine study at the NIMH in Bestheda, MD, but didn't want to go off the meds and I have a falling after only being off meds for a day or two. I've cheated (even though being risky) when going off/on different meds like Nardil to Cymbalta and Cymbalta to Parnate without any washout at all and started the next day without any serotonin syndrome effects.
Thanks for the suggestions.
Regards,
Jeff
Posted by CaptainAmerica1967 on December 13, 2008, at 15:33:09
In reply to Re: Treatment Resistant (Refractory) Depression, posted by SLS on December 12, 2008, at 11:24:18
" I wish clorgyline were still around."
Was it removed from the market because of FDA laws or just stopped being made? If it's still legal, then it can be manufactured by a chemist. I used to take GHB from health food stores and it was removed from them by the FDA and prior to the Xyrem RX form of GHB coming out, I had a compounding pharmacist, chemist make it for me.
Did it work well for you?
Posted by Racer on December 13, 2008, at 17:27:07
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 13, 2008, at 15:33:09
Hello, and welcome.
I've had my share of rides on the Medication-Go-Round, and finally found myself at an acceptable level of partial remission. I think I agree with both SLS and PolarBear, because I'm going to suggest a few things that are pretty similar to some of what you've already tried.
First, I'll add a vote for trying Provigil if you haven't already tried it with what you're on.
I had a less than pleasant response to Lamictal -- it was depressogenic for me, as were BuSpar, Seroquel, EMSAM, and I think Abilify. (I can't remember with Abilify -- it might just have made me too edgy?)
I did have a far better response to Trileptal -- it really made a surprising difference, despite my long standing dx of unipolar depression. (Unfortunately, I also had an electrolyte imbalance from it, so not taking it.)
As far as antidepressants go, Wellbutrin is my good and trusted friend, although it certainly can't be monotherapy. (Honestly, I'm not sure it's really doing much, or if it's just a sort of totem at this point.) Strattera, the ADHD drug, was pretty helpful for me, and might be worth a try if you get to that point.
It sounds as though you already know a lot of the usual suspects, and have tried most of them. There were a few articles a while back about a very short course of low dose dexamethasone to kickstart response -- it's certainly worthwhile to look into that. Although you haven't mentioned it, I'm sure you're on top of your thyroid levels, so I won't mention that.
All I can come up with to suggest, actually, would be trying Provigil -- and looking into a course of steroids. The articles I've read looked very, very promising.
Best luck, and again -- welcome to Babble.
Posted by CaptainAmerica1967 on December 13, 2008, at 19:05:23
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by Racer on December 13, 2008, at 17:27:07
Thanks for the info.
I had tried Provigil, but that was after going off the Nardil and going onto Cymbalta. Not sure if it helped as I was on so many other meds at the time, Pindolol, Lamictal, Thyroid, Androgel, Lithium, Wellbutrin, Selegiline and some other amphetamines as well. I've never tried Strattera I believe. Atypical antipsyotics like Abilify and Seroquel made my depression worse. I also was able to get a hold of and try the dopaminergic TCA called Survector (amineptine) which helped some and boosted my libido.
I've always wondered about the cortisol or cortitropin releasing factor impairment. Several CHF antagonist/blockers are being studied and are in stage II or III. (www.neurotransmitter.net/newdrugs.html)
Thanks again for your input.
Regards,
Jeff
Posted by Phillipa on December 13, 2008, at 19:22:48
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 13, 2008, at 5:05:06
Jeff my apolgies I missed this thread just seeing it now. If you like babblemail me and I'll explain things in detail to you. Somehow I feel like I already know you. Just click my posting name Phillipa in blue and a screen appears and it would be like private e-mail to me. I feel terrible I missed this. My sincerest apologies. Love Phillipa looking forward to hearing from you.
Posted by azalea on December 13, 2008, at 21:36:47
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 13, 2008, at 19:05:23
You mentioned LiOr in a previous post. I'm assume you're referring to lithium orotate. Have you tried lithium carbonate?
Also, I believe production of Survector (amineptine) has been discontinued in all countries. Amineptine is the predecessor of tianeptine, currently marketed as Stablon by Servier, the same company that made Survector.
I hope you find useful info here.
> Thanks for the info.
>
> I had tried Provigil, but that was after going off the Nardil and going onto Cymbalta. Not sure if it helped as I was on so many other meds at the time, Pindolol, Lamictal, Thyroid, Androgel, Lithium, Wellbutrin, Selegiline and some other amphetamines as well. I've never tried Strattera I believe. Atypical antipsyotics like Abilify and Seroquel made my depression worse. I also was able to get a hold of and try the dopaminergic TCA called Survector (amineptine) which helped some and boosted my libido.
>
> I've always wondered about the cortisol or cortitropin releasing factor impairment. Several CHF antagonist/blockers are being studied and are in stage II or III. (www.neurotransmitter.net/newdrugs.html)
>
> Thanks again for your input.
>
> Regards,
>
> Jeff
Posted by darwinsmunky on December 13, 2008, at 23:41:16
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by azalea on December 13, 2008, at 21:36:47
I dont mean for this to come off the wrong way but for someone suffering from a severe and chronic form of depression you certainly have shown a great deal of motivation. From trying damn near every alternative to meds, to writing an autobiography (and yet poor at school?). Perhaps part of the problem is not the depression, but rather the obsession you have with it and in turn the possibilty of you creating a psychosomatic response.
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