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Dr. Bob is Robert Hsiung, MD,
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Posted by johnLA on August 7, 2012, at 22:38:33
hi all-
i finally did my ketamine infusion last week. i'm very sorry to say that i did not get a positive result. possibly one day of placebo relief, if even that.
unfortunately as well, those that do not respond to the first infusion most likely will not respond to repeated infusions.
i am very disappointed to say the least.
still, many people that i have spoken to have had results that have lasted from a week to a month. so, those of you who have yet to try it please do not give-up hope.
so, what does a guy do who has tried ect, several ssri's, remeron, effexor and now ketamine, all w/out any positive results?
nardil? tca? some drug combo?
my depression is deep. i have basically been in bed for over 2 years now. not sure meds are the direction for me at this point. my biggest problems are inertia and ruminating thoughts.
maybe something more behavioral based?
finally, sorry to those who have emailed me and i did not respond. i have just been extra down this week.
john
Posted by johnLA on August 7, 2012, at 22:40:36
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
Posted by Tomatheus on August 7, 2012, at 23:56:19
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
JohnLA,
I'm sorry to hear that the results of your ketamine infusion weren't very positive. I would certainly recommend giving some of the medications that you haven't tried yet a chance, in combination with psychotherapy if at all possible. Have you tried Wellbutrin? If you haven't, I would probably recommend trialing it before moving on to the TCAs and MAOIs. Cymbalta is also an option, although I think that its chances of working aren't very good considering that you haven't noticed any positive results from Effexor or the SSRIs.
At this point, it sounds like you have some medication options that you haven't explored, so I would explore those options and also look into psychotherapy. If medications and therapy don't produce satisfactory results, there are always alternative treatments to consider, including St. John's Wort, SAM-e, fish oil, and others. Some dietary supplements can be used with medications, but some of them interact with medications, so as with all treatments, it's best to be cautious with alternative treatments.
Well, that basically sums up my thoughts on what your treatment options seem to be from my perspective. I wish that I can say from experience that a particular treatment is helpful, but nothing's really helped my depressive symptoms in the long run, so in some ways we may be in similar boats, so to speak. But I would certainly try to exhaust every option that you have available to see if you might land on something that will produce at least some positive results. Also, if you haven't already done so, maybe consider getting your thyroid tested, since the symptoms of thyroid disorders tend to mimic the symptoms of psychiatric disorders.
I hope this helps a little, and I wish you luck.
Tomatheus
Posted by brynb on August 8, 2012, at 0:08:26
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
> hi all-
>
> i finally did my ketamine infusion last week. i'm very sorry to say that i did not get a positive result. possibly one day of placebo relief, if even that.
>
> unfortunately as well, those that do not respond to the first infusion most likely will not respond to repeated infusions.
>
> i am very disappointed to say the least.
>
Hi John,I was thinking of you this week! I'm so sorry it didn't turn out as you hoped it would. It's understandably disappointing.
> so, what does a guy do who has tried ect, several ssri's, remeron, effexor and now ketamine, all w/out any positive results?
>
> nardil? tca? some drug combo?Are you compiling a list of all meds and combos and doses you've ever been on? It seems you haven't tried the MAOIs and TCAs, so perhaps that's a place to do some more research. Also TMS. And, there are many other off-label psych and non psych meds to explore as well.
> my depression is deep. i have basically been in bed for over 2 years now. not sure meds are the direction for me at this point. my biggest problems are inertia and ruminating thoughts.I could be wrong, but your depression sounds a bit Atypical (not that it matters) which would guide you to the MAOIs you mentioned earlier.
> finally, sorry to those who have emailed me and i did not respond. i have just been extra down this week.
>Glad you're back =). And it will get better. Hey, you just learned something new and though it may not seem so now, it could be a blessing, a lesson, or what you needed to do to get to where you are now, and that's a good place. Good because you now know what doesn't work and can move on from there. I'm sure it made you more self-aware, maybe hopeful as to other methods, etc. So, you lost nothing and gained some pretty invaluable knowledge!
b
Posted by Phillipa on August 8, 2012, at 0:24:44
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
John that stinks!!!! I'm so sorry. Always around. What have you been considering? I've forgotten all the meds you have trialed. I also have a theory from a book fiction but written by a doctor turned Author that immune system could be responsible for just about all illnesses including mental. I wonder if a better test than ANA? Hang in and have some chocolate. Love Phillipa
Posted by Phillipa on August 8, 2012, at 0:27:30
In reply to Re: ketamine infusion reults » johnLA, posted by Phillipa on August 8, 2012, at 0:24:44
Found this
Posted by SLS on August 8, 2012, at 7:34:19
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
Hi John.
> i finally did my ketamine infusion last week. i'm very sorry to say that i did not get a positive result. possibly one day of placebo relief, if even that.:-(
> unfortunately as well, those that do not respond to the first infusion most likely will not respond to repeated infusions.
>
> i am very disappointed to say the least.I am, too. I would have liked to see you get well.
> so, what does a guy do who has tried ect, several ssri's, remeron, effexor and now ketamine, all w/out any positive results?
>
> nardil? tca? some drug combo?I think you are far from being a hopeless case. You may need to take a combination of three or more medications. Which, if any, of the drugs you tried produced a partial or transient improvement? Which drugs made you feel worse?
Examples of combinations off the top of my head are:
Parnate + nortriptyline + lithium
Effexor + Wellbutrin + Lamictal
Abilify + Wellbutrin + Lamictal
Zoloft + nortriptyline + lithium
Abilify + Effexor + nortriptyline + lithium* Lithium and Abilify might best be used in low dosages when treating unipolar MDD.
It sometimes makes sense to remain on a drug or drug combination that has produced a partial improvement, and to build a regime around it.
Happily, each person is going to suggest a different set of combination treatments based upon their own experiences with them. The more tools, the better. Recently, Latuda (lurasidone) has been suggested to exert antidepressant effects, perhaps via 5-HT7 receptor antagonism.
For me, the addition of prazosin has helped a great deal. I can get out of bed and even read more easily. I still haven't decided for whom this drug is apt to produce an antidepressant response. However, it is such a benign drug, that it might be worth a try in combination with antidepressants. Prazosin might be particularly useful with noradrenergic drugs, but this is only a guess.
> my depression is deep. i have basically been in bed for over 2 years now. not sure meds are the direction for me at this point. my biggest problems are inertia and ruminating thoughts.
That sounds more like endogenous (melancholic) depression than atypical depression. It depends upon whether or not your problems with inertia is actually an expression of psychomotor retardation. Feeling worse in the morning is another clue indicating endogenous depression. Have you tried imipramine?
> maybe something more behavioral based?
Has this been suggested to you by a mental health professional? Is this a desperate guess made by process of elimination based upon non-response to antidepressant monotherapy?
I say that you should keep moving forward while occasionally looking back. Look back so that you can use the information you have gleaned from your history of responses to previous treatments along with an accounting of the course of your illness and any psychosocial stresses that acted to induce it. Having 20-20 hindsight can be useful.
I get the impression that Paxil is particularly effective as an SSRI. Have you ever tried it? Unfortunately, Paxil has been reported to cause birth defects involving heart and pulmonary valves. If pregnancy isn't an issue, it might make sense to give this drug a try. As with other SSRIs, it can poop-out and lose its effectiveness if discontinued and restarted.
You'll get there.
- Scott
Posted by papillon2 on August 8, 2012, at 8:08:23
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
> i finally did my ketamine infusion last week. i'm very sorry to say that i did not get a positive result. possibly one day of placebo relief, if even that.
Damn, that sucks. :-(
> So what do you suggest for a guy do who has tried ect, several ssri's, remeron, effexor and now ketamine, all w/out any positive results?
A tricyclic anti-depressant which you may need to combine with a mood stabilizer (e.g. Lamictal, Lithium) for extra effect? Lithium is good for ruminating thoughts especially if those thoughts involve suicidal ideation.
Hang in there.
Posted by Hugh on August 8, 2012, at 15:33:25
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
> so, what does a guy do who has tried ect, several ssri's, remeron, effexor and now ketamine, all w/out any positive results?
I'm sorry to hear that, John. I know your hopes were very high. You've had ect and tns at UCLA. Maybe you should try neurofeedback at UCLA. Thomas Brod is their neurofeedback clinician.
http://tbrod.bol.ucla.edu/neurofeedback/neurofeedback.html
I did neurofeedback in 2000, and it was helpful, though not as effective as I'd hoped it would be. There has been great progress in the field since then -- better equipment, better protocols. I hope to go in for another round of neurofeedback in the near future. Good luck with whatever you try.
Posted by Slabicki on August 9, 2012, at 23:16:00
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
Hi John,
It looks like you haven't explored your options yet.
I suggest thag you see a psychopharmacologist that can help you with a drug combo. You can find
the expert at Depression Central site.My best trycyclic was a Desipramine, you can try it in combination with Lithium.
Also, Sulpiride is a great drug.Can you share which place you've tried Ketamine?
I wish you good luck.
Slabicki
Posted by Slabicki on August 9, 2012, at 23:31:52
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
Hello again John,
I forgot to mention the combo that worked for me.
It's Moclobemide and Naltrexone.This is for people who develop the tolerance to meds. I used it in the past with success.
Naltrexone prevents poop out.
It's just an idea, so you have some options.
Posted by SLS on August 10, 2012, at 8:07:25
In reply to Re: My best combo ever suggestion » johnLA, posted by Slabicki on August 9, 2012, at 23:31:52
> Hello again John,
>
> I forgot to mention the combo that worked for me.
> It's Moclobemide and Naltrexone.
>
> This is for people who develop the tolerance to meds. I used it in the past with success.
> Naltrexone prevents poop out.
> It's just an idea, so you have some options.
Wow. Interesting treatment. What dosage of naltrexone did you use?Thanks.
- Scott
Posted by johnLA on August 10, 2012, at 12:50:00
In reply to Re: ketamine infusion reults, posted by Tomatheus on August 7, 2012, at 23:56:19
thank-you tomatheus for your reply.
i have tried wellbutrin in the past. it was extremely agitating...
having said that, my doc just prescribed 75mg this time around and told me to split the dose and see what happens after a few days.
i will say that when i was on the wellbutrin 2 years ago it was the only antidepressant that was activating. i believe i was taking 150mg per day. did not last long. the anxiety it caused was very difficult to deal with but, like i said the very first few days i was out of bed and out of the house.
maybe this baby dose and slow titration will be a way to go.
tried cymbalta. got nothing from it except a difficult withdrawal. i gave it a good 2 months i believe.
i eat a lot of salmon. about 2 times a week. and, i have been taking a very high grade fish oil supplement. covered there.
i kind of quit therapy, but am about to start-up again. i am also possibly going to do a an out-patient program at a small hospital near me.
that's the plan now.
thanks again for your reply.
john
ps i also visited your blog. i enjoyed it. you write extremely well. the old high school teacher in me always enjoyed/respected those that could express themselves well in writing. :)
Posted by johnLA on August 10, 2012, at 12:57:25
In reply to Re: ketamine infusion reults » johnLA, posted by brynb on August 8, 2012, at 0:08:26
thnx bryn for your kind words and advice.
yes, there are still a lot of drugs to try.
i have not tried any tca's or maoi's yet.
i did try ect and it didn't work too much. i heard if you fail ect then most likey you are not a good candidate for tms? i may be wrong on this. i'll research this a bit more.
well, form one teacher to another; this is one hell of a lesson i have been going thru for the past 2+ years. if i get well, ok, WHEN i get well, i will possibly be the happiest i have ever been. though, i was pretty happy/content most of my life until a perfect storm came together in 2009/2010 that just broke me. plus, looking back i may have been in a mild depression for a few years before. still, i was living a very good life until my brain finally had enough after too many stressful events.
thanks again bryn. thnx too for your email.
john
Posted by johnLA on August 10, 2012, at 13:09:14
In reply to Re: ketamine infusion reults, posted by Phillipa on August 8, 2012, at 0:27:30
thnx phillip for your reply and the link.
my therapist thinks that of all the stresses that caused my depression, the physical losses may be playing the biggest role.
as you know, having no sense of smell and a very low sense of taste is downright depressing in itself. i also had/have several other physical issues since my early 40's.
i was always very active and healthy. highschool and college football, marathons and triathalons after college, gym rat right-up to the day my brain switched.
now, 50 dealing with chronic asthma, replaced hip due to arthritis, i even got toe nail fungus somewhere during my depression!? (i think it was when i went for only pedicure in my life right after my hip was replaced, still it sucks. i hate looking at the fungus!) also, chronic nasal polyps. coming-up on a 3rd sinus surgery at some point.
anyway, yeah, middle-age is a biatch. add to that, that i have not worked-out in over 2 years. blows my mind. i have weighed the same since i was 18...until remeron...since stopping remeron i am back to my original weight w/no muscle. i actually have small 'man boobs' for the first time in my life. i look in the mirror (when i shower about once a week!) and say 'who is that middle-aged dude?!
john
Posted by johnLA on August 10, 2012, at 13:28:43
In reply to Re: ketamine infusion reults » johnLA, posted by SLS on August 8, 2012, at 7:34:19
thanks as usual scoot. really appreciate your reply.
the only drugs that i responded to both in a positive and negative way have been remeron and wellbutrin and klonopin.
remeron was bliss at first; simply because i never slept so well in my life. i have mild sleep apnea. i mean it was like i had jet-lag type of deep continuous sleep. no real help with mood though or rumination or energy. crazy dreams too. i just came-off it. sometime i take a bit to get some extra sleep, but it never really helped my depression. i was on it for 1.5 years. pretty easy to get-off of actually. i had read horror stories here on babble (old posts) which scared me. not my experience at all.
wellbutrin, i have already mentioned in the above posts.
klonopin. i take 2mg a night. sure wish i could get off it. i am curious as to how i would feel w/out it. all my docs do not seem concerned and i have asked everyone of them about it adding to my depression. they say no. it does work for my anxiety. i was always a little anxious before all this happened. but, i don't like how mellow i am on it. thinking of slowly reducing at some point. not sure if it's the depression or the klonopin that is causing me brain fog.
i did try effexor and lasted about a week. pretty bad headaches/etc. i am such a wuss. still, it just didn't feel right.
my current pdoc has been really pushing low-dose abilify. i'm scared of the stuff. ironic, since i did ect! anyway, i'd rather try some other stuff before i go the ap route.
as mentioned i have not tried any tca's or maoi's. been thinking about nardil a lot.
also, i know you tried ect a long time ago. you have mentioned possibly doing tms. have you read/heard that tms is not effective for those that failed ect? curious about that.
finally, i am not too keen on taking multiple drugs. i'm stubborn and concerned about the side-effects. still, i will keep your thoughts as possible options for down the road.
thnx again scott for all the good advice.
john
Posted by johnLA on August 10, 2012, at 13:32:42
In reply to Re: ketamine infusion reults, posted by papillon2 on August 8, 2012, at 8:08:23
thnx papilon.
lithium...hmmm...i'd like to hear more about this one. especially when you mention suicidal rumination being 'quieted.'
again, i hear such negative info about side effects. i will bring this up w/my pdoc though.
thanks again.
john
Posted by johnLA on August 10, 2012, at 13:34:25
In reply to Re: ketamine infusion results, posted by Hugh on August 8, 2012, at 15:33:25
thnx for the link and advice hugh, i appreciate it.
i might just try it.
any approach that is med-less (is that a word?) really appeals to me.
john
Posted by johnLA on August 10, 2012, at 13:42:03
In reply to Re: ketamine infusion reults, posted by Slabicki on August 9, 2012, at 23:16:00
hi slabicki-
i did my infusion at uc san diego under dr david feifel. great and very caring doc. total cost was about $700.
dr randall espinoza also does it at ucla for about $1250. and, much bigger hassle to get it done at ucla; they need a physical, blood work, etc.
can i ask your experience about lithium? are you straight depression or on the bp spectrum? i have straight mdd.
thanks for the info about depression central. i'll take a look.
john
ps not sure where you are located, but more and more docs are doing ketamine. most are associated with universities, but not all. i have just learned of a doc in NYC name dr. fruitman (really!) who actually gives ketamine in a shot! for $250. on another form i have met a guy who does it about once a month and it is working for him.
Posted by johnLA on August 10, 2012, at 13:43:29
In reply to @ slabicki, posted by johnLA on August 10, 2012, at 13:42:03
Posted by Tomatheus on August 10, 2012, at 15:17:30
In reply to @ tomatheus, posted by johnLA on August 10, 2012, at 12:50:00
John,
Thank you for getting back to me. I'm sorry that you found Wellbutrin to be agitating the first time that you tried it, but it's good to hear that you're giving the medication another try. It sounds like you're attacking your depression from as many angles as possible with the Wellbutrin, the fish oil, and the therapy that you're planning to start, and I can only hope that your multi-modal sort of approach will produce some positive results. I also hope that you won't find the agitation and anxiety from the Wellbutrin to be too much for you this time around, with you titrating the medication slowly. So, I'd like to wish you luck with your new Wellbutrin trial and also with the therapy that you'll be entering into.
Also, thank you for visiting my blog and for complimenting me on my writing. I appreciate the fact that you took some time to read what I've written about my battles with mental illness, and I'm especially glad that you enjoyed what you read.
I would encourage you to keep us posted on how things go with your Wellbutrin trial. If you don't end up responding well to Wellbutrin this time around, you do of course still have the TCAs and MAOIs to try, and I would say that there is a good chance that you might benefit from one of those medications, either alone or in combination with another medication. Of course, hopefully things will go well with the Wellbutrin, and you won't have to worry about trying either a TCA or an MAOI. I'm just saying that you'll still have some effective options to choose from if things don't end up working out with your current treatment.
So, again, I'd like to wish you luck with your treatment. Let's hope that the Wellbutrin that you're taking will end up being what you need to stay out of bed and that it will help you beat your depression.
Tomatheus
Posted by 10derheart on August 10, 2012, at 16:02:02
In reply to ok...i broke the rule of 3! where is lou? ;) (nm), posted by johnLA on August 10, 2012, at 13:43:29
Hi JohnLA. I am so sorry your latest attempt to fight your illness did not work out. I wish I had some brilliant advice, but I don't. I wish you well.
But anyway....I'm clearly not Lou, but you didn't break that rule. It's never applied when you are replying individually to others. You'll have to try a lot harder to rebel against a Babble guideline, I'm afraid! ;-)
I am wondering,though, just from curiosity, why you use the @ symbol instead of the 'add name of previous poster' box which inserts the posters name? Two or three other posters do that as well, and I always wonder.....
Not that it matters one bit.....I just have that sort of mind, always inquiring....{strange}
Posted by SLS on August 10, 2012, at 16:09:57
In reply to Re: ok...i broke the rule of 3! where is lou? ;) » johnLA, posted by 10derheart on August 10, 2012, at 16:02:02
You are the sweetest...
:-)
- Scott
Posted by phidippus on August 10, 2012, at 18:32:27
In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33
CBT andd MAOIs?
Eric
Posted by Slabicki on August 11, 2012, at 15:31:14
In reply to @ slabicki, posted by johnLA on August 10, 2012, at 13:42:03
Hello JohnLA,
Thank you for posting that info, it was really helpful.
I don't have much experience with Lithium, as I developed drug resistance. I remember it worked for a short time only and lifted depression.
I have mostly depression, and I developed SAD when
on AD's in the past. So maybe it's Bipolar NOS,
since I never had mania.Slabicki
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