![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 76. Go back in thread:
Posted by DavidSmith on December 26, 2012, at 19:13:28
In reply to Re: Brynb - Please be civil. » DavidSmith, posted by brynb on December 26, 2012, at 18:35:56
Dear Bryn,
You have my sincere apology.
I know that there are people
on this site who are hurting other posters
(whether intentionally or not).I also recognize that I do not post often
and that your history with Lou is different (perhaps) than mine.What I am concerned about is maintaining
a positive vibe and I thought the words:
"and clearly you don't" were hurtful.I know personally about racism
and many of the other "isms" out there.
It does not feel good.
I have had strangers say to me:
"You're a little different, aren't you?"I thought that the main point of
Dr. Bob's civility rule is to generate positive
feelings within ourselves, thereby
strengthening the GOOD pathways in our brain.
I hope you feel better starting right now.Again, please accept my apologies for being overly critical.
David
Posted by baseball55 on December 26, 2012, at 19:19:16
In reply to feel finished, posted by g_g_g_unit on December 26, 2012, at 7:48:12
I was in the depths of despair a year and a half ago. I could find no reason to go on. I was desperate and suicidal. I had tried all kinds of drugs, ECT, bilateral ECT, the gamut. My p-doc insisted I try DBT which I had tried before in a group and hadn't really benefited from. I found a DBT therapist, the three of us met together and I made a committment to try for three months, to really work at it and promise to keep myself alive. It worked. I've worked hard at it. You have to work hard at these things. It's no joke to be suicidal and consider leaving your family devastated. I also found that lamictal helps reduce suicidal thoughts. It doesn't do much else, but for me that's enough. There is help. You just have to force yourself to find the resources to look for it and to work on it.
Posted by Lou Pilder on December 26, 2012, at 19:21:49
In reply to Re: Brynb - Please be civil. » DavidSmith, posted by brynb on December 26, 2012, at 18:35:56
> > "Seriously, Lou, if you have nothing positive to add, and clearly you don't, then DON'T WRITE ANYTHING."
> >
> > Lou, your concerns about a life based upon "future treatments" are justified.
> >
> > At 54, I finally realize that happiness and wholeness comes from serving others.
> > If we put that within a Christian framework then it becomes obvious.
> >
> > Meds can help but they should not become a lifestyle.
> > BTW, shouldn't the original post be in Psycho-Babble Psychology?
> >
> >
> Did I miss something here? How, in any way, am I being uncivil in what I wrote? Is it less civil than being called (in other posts) an anti-semite (when I'm Jewish, to boot), or a list of other ridiculous sounding accusations?
>
> I'd like to think that I contribute positivity to this forum, and I've had only positive experiences and positive connections here until now.
>
> I'm currently in a very depressed state and feel quite similar to g unit. And I'm feeling very sensitive. Perhaps overly sensitive, but your comment really hurt me.
>
> What's uncivil about telling a poster who continuously hijacks threads to promote his thoughts on psychopharmacology to not do so when he's not adding something positive? Did I use profanity? Was I terribly rude? I don't think so, and I doubt many others here who have taken offense to Lou would agree.
>
> I believe an apology is in order.
>
> -bryn
>
>
> bryn,
You wrote,[...called an xxxx...or a list of other..accusations...].
I need to post a response to you here now. I want you to post here now:
A.post the link that has what you say I called you an xxxx
B. post the links to what you say are other accusations.
If you are not going to afford me the opportunity to defend against such defamation toward me here, then I think that could cause the deaths of others by the nature that the defamation toward me could cause others to see me in a false light and ignore my warnings to them that these drugs could cause one to be compeled to commit suicide or murder and then take them, or drug their child in collaboration with a psychiatrist/doctor and their child goes on to a lifetime of suffering and addiction to these drugs.
Lou
Posted by DavidSmith on December 26, 2012, at 19:28:07
In reply to Lou's response-wazklwabeht » brynb, posted by Lou Pilder on December 26, 2012, at 19:21:49
And now we see how diverse mental illness can be.
Posted by Emme_V2 on December 26, 2012, at 19:34:53
In reply to feel finished, posted by g_g_g_unit on December 26, 2012, at 7:48:12
> I had no idea that things could reach this point. I've found myself in the pits of depression, agony, despair and so on but always felt some sense of hope or reason to continue.
>
> Now that I've exhausted most pharmacological options and turned quite a pivotal age (27), I've found myself stuck in what I can only describe as an "existential depression". Everything feels utterly pointless. I feel lost, like my dreams are gone, there is nothing to direct myself towards anymore, no vision of a future .. nearly all of my 20s have been consumed by this horrible illness.
>
> I don't know what to do anymore. I know there is only so much professionals can do, but the problem is I don't care about myself enough anymore to want to work with them. My OCD has reached such a terrifying apex that I couldn't even begin to describe how much bizarre phobic avoidance etc. I go through. Trying to piece together some semblance of a life at this point seems impossible. I don't want to live a compromised life, always battling this illness. I *know* that I could have been capable of so much more, and that thought -- what could have been -- eats me up.
>
> I guess this is kind of attention-seeking, but I don't know what to do to help myself. I feel like I'm trying to destroy myself .. I binge on junk food, I've stopped exercising and grooming, I sleep as much as I can, I've started abusing certain prescriptions just so I can socialize occasionally (which is something I never would have done in the past). My therapist gave me suggestions, but I don't even bother enlisting them. I feel like I've just been going round in circles in treatment for the past 6 years, and sitting in a park or listening to calming music isn't going to give me a life back.
>
> I added hospital cover to my health insurance, which means I can qualify for private in-patient treatment at the end of February. But I really struggle to see what a hospital can do that my psychiatrist couldn't. I guess there are certain options I could try, like high-dose SSRI or whatever, but I don't want to end up so numbed/sedated etc. that life just becomes a purgatory.
>
> Sorry for the self-pitying nature of this post. I guess what I'm trying to say in a way is that I really applaud you guys, for continuing to move forward in spite of everything. SLS is really one of the most inspiring people I have come across, and I mean that .. your courage and resilience baffles me.Hi there. Quick note. I'm sorry you're suffering so much. The existential depression you're describing is a terrible state to be in. The horrible things going through your head are a product of the depression. That whole no-vision-of-future thing? Yes, it is the pits. I know it may not feel like it, but 27 is awfully young. I promise you it is. It does sound like a hospital stay might be helpful, but that's a long ways off until late February.
Although I know you're feeling overwhelmed, can I ask a few questions? You may have answered these elsewhere. What do you think of your pdoc? Is he or she up on the research, knowledgeable about the older drugs, etc.? Have you been for a consulting opinion with someone else? Sometimes, no matter how good our doctors are, they need some extra input. What have you been on so far? I'd be surprised if you've truly exhausted all drug options - there's lots of ways to combine things.
Do you feel like your therapist is a good fit?
Have you been tested for thyroid function, B12, vitamin D, etc.? If any of those is off, it'll make things worse. Is there a seasonal component to your suffering?
Then there are alternative remedies (SAM-e, etc.).
What I'm saying is, odds are there are still things to try. It's a real endurance test to survive through all of this. However, you are in good company, so keep fighting!
Posted by DavidSmith on December 26, 2012, at 20:05:03
In reply to Re: feel finished, posted by baseball55 on December 26, 2012, at 19:19:16
Thanks for the tip on DBT.
Wikipedia has a great article on it.
Posted by Phillipa on December 26, 2012, at 20:38:24
In reply to Re: Brynb - Please be civil. » DavidSmith, posted by brynb on December 26, 2012, at 18:35:56
Bryn I definitely back you with your statement. You said nothing wrong at all. Phillipa
Posted by SLS on December 26, 2012, at 23:36:44
In reply to Re: Lifestyle, posted by DavidSmith on December 26, 2012, at 18:51:45
Words are important.
> When I started this journey with psychiatry
> (twenty years ago!), I often looked for the
> new or better medication which would help me.What was wrong with you such that you felt the need to take your first step into the world of psychiatry?
> I should have been looking at how I was living my life instead.
"Instead"? How did psychiatric treatment prevent you from looking at how you were living your life? I can do this while remaining in psychiatric treatment. I don't imagine that I am unique in this regard. Perhaps somatic psychiatric treatment was never appropriate for you.
> I relied on the medications to make me happy.
That was a mistake. Where did you get this idea from?
> Even though I found solace and stability in pills,
How so? From what did you seek this solace? What kind of stability did you find in pills? How did you know that you were more stable?
> I still kept myself removed from the world
> and perhaps that was my biggest mistake.I find that my illness separates me from the world. The depressive state is intrinsically isolating. It is not a matter of choice.
> Now my expectations are more realistic.
Your expectations *are* a matter of choice.
> After twelve therapists, I found someone I would
> listen to (THANKS DALE!).Dale must be a good match for you.
> Meds do have their place.
What is their place?
> But it is not appropriate for us...
"Us"? You and who else?
> ...to make detailed suggestions and combinations to people we meet online.
Why not?
> Christ, Buddah, whatever your preference.
Okay.
You wrote, "At 54, I finally realize that happiness and wholeness comes from serving others. If we put that within a Christian framework then it becomes obvious."
It might be obvious to *you*, but not necessarily to "we" or "us". If I do not choose to put happiness and wholeness within a Christian framework, would it thus never be obvious to me?
Whenever I see someone forcing the word "we" or "us" on others, I tend to wonder from where comes their need to include others in their indoctrinations.
I know, I know. You didn't force anything on anyone...
You and I aren't we. We are you and me. (I'll need to think about that one for awhile).
> I am impressed with the introspection g_g_g_unit has made.
Which one in particular has he made? Why are you so impressed with it?
For what it is worth, I am impressed with his g_g_g_unit's self-awareness and persistence. I am impressed with his determination in the face of many painful disappointments and for remaining receptive to new ideas. For me personally, if he were to find his healing in acupuncture, psychoanalysis, yogurt, or religion, I would be just as happy as if it were to come through one of SLS's treatment suggestions.
> They have all the tools to make the right choices for themselves.
I don't understand what you are saying here. Who is "they", what are the "tools", and what are the "right" choices compared to the wrong choices? I can't figure it out from context.
I need to stop here. I'm getting hoarse.
- Scott
Posted by g_g_g_unit on December 27, 2012, at 0:47:24
In reply to Re: Lifestyle » DavidSmith, posted by SLS on December 26, 2012, at 23:36:44
I just wanted to thank you all for your support and suggestions. I feel a little too overwhelmed to respond individually at this point, but I realize that I have quite a difficult decision ahead of me -- namely to continue with life, treatment and all the attendant hardship it brings -- or to surrender to my own nihilistic impulses. Right now, I feel like I'm in a hole that I'm not going to dig myself out of. I also realize that no one can make that decision for me.
It isn't so much the depression -- if it was depression alone, I could make some changes (maybe work, move out of home) which would help a lot; it's the relentless anxiety and OCD and agoraphobia which rule my life, and which I feel no reprieve from.
Posted by jono_in_adelaide on December 27, 2012, at 2:24:48
In reply to thanks » SLS, posted by g_g_g_unit on December 27, 2012, at 0:47:24
GGG, can i suggest you look at treatment at the Black Dog Institute in sydney - they are reputed to be extremely good at treating depression and anxiety disorders
http://www.blackdoginstitute.org.au/
They do inpatient and outpatient treatment
And can I reiterate, you have a life threatening, life destroying condition, be prepared to put up with some minor side effects if your condition can sucsessfuly be treated
Posted by g_g_g_unit on December 27, 2012, at 3:06:42
In reply to Re: thanks, posted by jono_in_adelaide on December 27, 2012, at 2:24:48
> GGG, can i suggest you look at treatment at the Black Dog Institute in sydney - they are reputed to be extremely good at treating depression and anxiety disorders
>
> http://www.blackdoginstitute.org.au/
>
> They do inpatient and outpatient treatment
>
> And can I reiterate, you have a life threatening, life destroying condition, be prepared to put up with some minor side effects if your condition can sucsessfuly be treatedI can't afford to get to Sydney. If I do inpatient treatment, it will be at The Melbourne Clinic.
And for the record, I've never discontinued a med due to minor side-effects -- it's generally stuff that obstructs my quality-of-life or a case of the cure-being-worse-than-the-disease.
But I should probably start to accept I'm not going to get the life I want, which means devoting a lot of time to fighting this monstrous OCD.
Posted by SLS on December 27, 2012, at 7:15:29
In reply to thanks » SLS, posted by g_g_g_unit on December 27, 2012, at 0:47:24
> I just wanted to thank you all for your support and suggestions. I feel a little too overwhelmed to respond individually at this point, but I realize that I have quite a difficult decision ahead of me -- namely to continue with life, treatment and all the attendant hardship it brings -- or to surrender to my own nihilistic impulses. Right now, I feel like I'm in a hole that I'm not going to dig myself out of. I also realize that no one can make that decision for me.
This is absolutely true. I am a believer that people have a right to choose their own destiny, even if that means choosing death. I have reached the point on two or three occasions when I contemplated a "rational suicide", or what I like to call autoeuthanasia. They shoot horses, don't they? However, I would council you against making a decision to move in that direction while you are experiencing such a severe episode of depression and anxiety. I am sure you actually "feel" doomed. This usually passes in cases like yours. I don't think it would be rational for you to commit suicide while you are in this state. You can choose to leave life anytime. Why do it today? I lived many years believing that suicide was to be an inevitable conclusion to my life. However, on a daily basis I was able to rationalize living for just one more day. I have never made plans nor investigated methods. One would think that I would have researched the thing. Nope. I wanted to distance myself away from suicide as much as possible. I don't want to have the tools ready to act on impulse. As long as I chose to live that one more day, it made no sense to add to my morbidity by investigating suicide. I seem to always work to gain positive energy.
I know that I have said this before, but I find hope in uncertainty. If you can conceive of a treatment that you have not yet tried, there is hope that you might find therapeutic success. If you cannot conceive of such a treatment, then let other people do it for you. Hopefully, this will be your doctor who offers you untried alternatives. Perhaps you will find hope in treatments that are not pharmacological. Certainty can be a killer. I reached my only state of certainty a little over a year ago. I could not conceive of any treatment that I had not yet tried. In my mind, I had run out of alternatives. I was certain I was doomed to live in a chronic state of severe depression and the pain and ruination that accompanies it. Thus began my existential crisis. My thoughts were deep, intense, and destructive. It is not that the thoughts were without fact to justify them. It is that they were exaggerated by the depressive state. The depressed brain sees life through unrealistic filters. There are no positive thoughts. The brain simply does not generate them. What's worse, it seems that the brain generates and exaggerates negative thoughts. So, in the nomenclature of behaviorists, the result of these filters is a lack of reward and/or a preponderance of punishment. Before making any decisions, you may want to wait for the negativistic brain state to subside so that any choice you make will be the result of a more objective deliberation. If you wait, I am hoping that the world will seem different enough for you such that you don't choose death today nor tomorrow.
> It isn't so much the depression -- if it was depression alone, I could make some changes (maybe work, move out of home) which would help a lot; it's the relentless anxiety and OCD and agoraphobia which rule my life, and which I feel no reprieve from.
Depressed people commit suicide more often when anxiety or anger are present. Anxiety is an intergral part of OCD. It is often considered a type of anxiety disorder. You must be in a hellish state right now. You must be ruminating to the point of exhaustion. Do you feel the intense anxiety viscerally? Do you feel it in the pit of your stomach and experience heart palpitations? I experience these things when I am overwhelmed and are plagued by thoughts of inevitable doom. There seems to be a neurobiological substrate for the suicidal brain. Mine was created by a depressive rebound from discontinuing Viibryd (vilazodone) abruptly. It sure didn't feel biological, though. However, my doctor knew better. The beast will beguile you. I do not believe that your suicidal brain state will last for very long. However, you might need help to process your existential crisis - the thought content of which reflect real issues - until your suicidal state subsides.
Try not to feed the beast.
Anyway, let today not be the day that you act irrevocably. You will get through this. You will be okay.
Are there any crisis services available to you? Please keep reaching out.
- Scott
Posted by g_g_g_unit on December 27, 2012, at 8:41:23
In reply to Re: thanks » g_g_g_unit, posted by SLS on December 27, 2012, at 7:15:29
> This is absolutely true. I am a believer that people have a right to choose their own destiny, even if that means choosing death. I have reached the point on two or three occasions when I contemplated a "rational suicide", or what I like to call autoeuthanasia. They shoot horses, don't they? However, I would council you against making a decision to move in that direction while you are experiencing such a severe episode of depression and anxiety. I am sure you actually "feel" doomed. This usually passes in cases like yours. I don't think it would be rational for you to commit suicide while you are in this state. You can choose to leave life anytime. Why do it today? I lived many years believing that suicide was to be an inevitable conclusion to my life. However, on a daily basis I was able to rationalize living for just one more day. I have never made plans nor investigated methods. One would think that I would have researched the thing. Nope. I wanted to distance myself away from suicide as much as possible. I don't want to have the tools ready to act on impulse. As long as I chose to live that one more day, it made no sense to add to my morbidity by investigating suicide. I seem to always work to gain positive energy.
Thank you, Scott. I was hesitant to mention the "S" word, but I suppose it was implied in my post. I have no plans to leave this world today, tomorrow or in the foreseeable future, but it is certainly something that I have begun contemplate with greater openmindedness. I do not subscribe to the theory that all suicide, enacted in the context of mental illness, is by default irrational. You are right -- I feel doomed and imprisoned, both internally and externally. This has been a slow process of degradation that I have been undergoing for 5 years, with almost no signs of reprieve. It is the continual process of reality clashing with fantasy which produces the greatest despondency.
>
> I know that I have said this before, but I find hope in uncertainty. If you can conceive of a treatment that you have not yet tried, there is hope that you might find therapeutic success. If you cannot conceive of such a treatment, then let other people do it for you. Hopefully, this will be your doctor who offers you untried alternatives. Perhaps you will find hope in treatments that are not pharmacological. Certainty can be a killer. I reached my only state of certainty a little over a year ago. I could not conceive of any treatment that I had not yet tried. In my mind, I had run out of alternatives. I was certain I was doomed to live in a chronic state of severe depression and the pain and ruination that accompanies it. Thus began my existential crisis. My thoughts were deep, intense, and destructive. It is not that the thoughts were without fact to justify them. It is that they were exaggerated by the depressive state. The depressed brain sees life through unrealistic filters. There are no positive thoughts. The brain simply does not generate them. What's worse, it seems that the brain generates and exaggerates negative thoughts. So, in the nomenclature of behaviorists, the result of these filters is a lack of reward and/or a preponderance of punishment. Before making any decisions, you may want to wait for the negativistic brain state to subside so that any choice you make will be the result of a more objective deliberation. If you wait, I am hoping that the world will seem different enough for you such that you don't choose death today nor tomorrow.I hope so too. My personal psychiatrist has run out of treatment ideas -- our last appointment was a medication review, where he established that the priority should be to reign in the severity of my anxiety. He prescribed Xanax, which produced a paradoxical reaction, and is now on vacation, so I don't have access to him until the second week of January. As far as depression, the only thing that produced any significant gains, looking back, was Parnate (at 60mg) -- I became far more active, engaged, and motivated, though at the expense of insomnia, increased anxiety and agitation. Dexamphetamine also helps my amotivational and concentration issues (perhaps partly tied to ADD), though at the expense of anxiety and agitation as well.
I notice the bind I am in. I am suffering from such severe anxiety that I am effectively crippled, yet am so desperate to maintain some idealized quality-of-life. Maybe this is just a normal reaction to the whole process of medicating. But I fear that anything that produces a meaningful dent in my anxiety will come at the expense of apathy, anhedonia, etc. The last time I was referred to a Professor of Pharmacology for a consultation he had me on a high-dose of Lexapro and Zyprexa and I barely had the willpower to get out of bed.
>
> > It isn't so much the depression -- if it was depression alone, I could make some changes (maybe work, move out of home) which would help a lot; it's the relentless anxiety and OCD and agoraphobia which rule my life, and which I feel no reprieve from.
>
> Depressed people commit suicide more often when anxiety or anger are present. Anxiety is an intergral part of OCD. It is often considered a type of anxiety disorder. You must be in a hellish state right now. You must be ruminating to the point of exhaustion. Do you feel the intense anxiety viscerally? Do you feel it in the pit of your stomach and experience heart palpitations? I experience these things when I am overwhelmed and are plagued by thoughts of inevitable doom. There seems to be a neurobiological substrate for the suicidal brain. Mine was created by a depressive rebound from discontinuing Viibryd (vilazodone) abruptly. It sure didn't feel biological, though. However, my doctor knew better. The beast will beguile you. I do not believe that your suicidal brain state will last for very long. However, you might need help to process your existential crisis - the thought content of which reflect real issues - until your suicidal state subsides.To be honest, I live in such a constant state of fear that I don't even ruminate anymore. It's like my mind is frozen and barely able to think due to having to remain in such a constant state of hypervigilance. Perhaps my unconscious goal is to suppress thought since it seems so threatening; I spend my days in a constant state of meaningless distraction .. sleeping, playing video games, watching TV. I worry for my cognitive function. I don't see how it is possible to construct a meaningful future -- based on intellectual pursuit -- when I have basically fallen off the face of the planet. The circumstances that triggered my suicidal state (a relationship ending, Memantine failing me, diminishing med options) don't leave me in a state of 'chemical withdrawal' which somehow feels temporary -- I genuinely believe that it is no longer possible to etch out a meaningful future with my current malfunctioning brain, and sometimes it feels very tempting to just admit valiant defeat and put an end to things rather than face further humiliation.
>
> Try not to feed the beast.
>
> Anyway, let today not be the day that you act irrevocably. You will get through this. You will be okay.It won't be today. I will at least attempt inpatient treatment, though unfortunately have to wait until the end of February to be admitted.
>
> Are there any crisis services available to you? Please keep reaching out.
>
Well, there are things like lifeline etc. but I find them a little condescending. My last psychologist just left his practice to enter research but has said I am free to call him in cases of emergency.Anyway, I really appreciate your support and guidance.
Posted by schleprock on December 27, 2012, at 12:58:26
In reply to Re: feel finished » g_g_g_unit, posted by SLS on December 26, 2012, at 11:33:05
> > I had no idea that things could reach this point.
>
> Yes, they absolutely can.
>
> > I've found myself in the pits of depression, agony, despair and so on but always felt some sense of hope or reason to continue.
>
> You have a number of choices. All but one of them require that you remain alive.
>
> I won't go fishing for a treatment option for you at this time. You know that I would probably come up with something. If not me, someone else will. I'm sure it won't be easy, but you cannot be certain that you will never find a treatment that will work. You don't know for certain that you are doomed to live out your life in the altered state of depression. Fortunately, new and novel drugs are still being developed to treat it.
>
> Just over a year ago, I had reached the same point of despair and demoralization as you seem to have. I had reached the end of the line. There were no more treatments that I could come up with. Viibryd had been my last chance to get well. I experienced a major existential crisis for which I saw no escape. However, as my doctor had so accurately concluded, much of the origin of this intense episode was the result of discontinuing Viibryd too abruptly and experiencing a withdrawal depressive reaction with anxiety and suicidality. I insisted that he was wrong, however. It felt like my thoughts were the cause of my feelings of doom, and not some drug reaction. The content of my thoughts were certainly real enough and based upon my taking stock of my life and the prospect of being doomed to forever live a subhuman existence. The circumstances of my plight were real. As I learned afterwards, it was indeed Viibryd withdrawal depression that amplified my reaction to those very real life circumstances. As my doctor suspected, the suicidal state resolved despite nothing being different in my those circumstances. Still, I remained pessimistic. I don't know what I would have done had prazosin not produced a significant improvement in my condition a month later. It is possible that I would have come closer to suicide, even though the withdrawal depressive state had disappeared on its own.
>
> > Everything feels utterly pointless.
>
> I can totally understand this.
>
> > I feel lost, like my dreams are gone,
>
> My dreams died many years ago. I had quite a few.
>
> > there is nothing to direct myself towards anymore, no vision of a future .. nearly all of my 20s have been consumed by this horrible illness.
>
> It is a terrible loss. An important decade of your life is being stolen from you through no fault of your own. Many people try to help, but the illness is just too powerful and unrelenting. I am having a difficult time accepting the theft of my teens, 20s, 30s, 40s, and now my 50s.
>
> You are 27.
> 27 is old.
> 27 is young.
>
> When I reached age 32, I felt old. I felt that life had passed me by. I had missed everything. Older people insisted that I was still very young and had the better part of my life ahead of me. I didn't believe them. I sure didn't feel young. I was just too young to know any better.
>
> Take my word for it. You are still very young.
>
> > I don't know what to do anymore.
>
> I know what it is like to reach a wall at which there are no remaining treatment alternatives to break through it. You have exhausted all of them. There is no hope. I usually find hope in uncertainty. A year ago, I reached a point at which I became certain that I was to die ill. My greatest fear was to be realized: I was to die without ever having lived. At age 52, I had reached a seminal moment in my life.
>
> > I know there is only so much professionals can do, but the problem is I don't care about myself enough anymore to want to work with them.
>
> Do you feel as though you are always at odds with your doctors? If so, why?
>
> > My OCD has reached such a terrifying apex that I couldn't even begin to describe how much bizarre phobic avoidance etc. I go through.
>
> I do not have OCD. However, for many years while I was at my baseline severity of depression, I would hide whenever someone would walk or drive by the house. I didn't want to be seen through the window. I am not sure why. Avoidance was just part of the illness. What was particularly frustrating and confusing to me was that I really do love people. For some reason, I was just afraid of being around them. I found that when I reach remission or have a brief robust response to treatment, I become quite gregarious and don't mind being surrounded by a sea of people. I can tell that people genuinely like being around me. I am engaged. Depression disengages me. People are uncomfortable around me because I am mute and not very accessible. They can sense my discomfort to be in a social gathering. I have nothing to talk about. I just want to go home and be left alone.
>
> > Trying to piece together some semblance of a life at this point seems impossible. I don't want to live a compromised life, always battling this illness. I *know* that I could have been capable of so much more, and that thought -- what could have been -- eats me up.
>
> I have been devoured, regurgitated, and devoured again. This illness has pummeled me into submission. I reached this state about 10 years ago. I could no longer maintain my positive energy and enthusiasm. Much of me is now gone. I don't feel me inside me anymore. I don't think these parts of me will ever reappear. I can't think about these things anymore. They will never again exist. My best years have been forever stolen from me. My only desire now is to be able to actualize my remaining moments in life with peak experiences, despite my lack of achievement. This can only happen for me if I emerge from depression.
>
> > I guess this is kind of attention-seeking,
>
> No. It is a kind of help-seeking.
>
> > but I don't know what to do to help myself.
>
> Exactly.
>
> > I feel like I'm trying to destroy myself
>
> No. The illness is destroying your morale. Without morale, you are easy prey for the depression to cause you to:
>
> > .. I binge on junk food, I've stopped exercising and grooming, I sleep as much as I can, I've started abusing certain prescriptions just so I can socialize occasionally (which is something I never would have done in the past). My therapist gave me suggestions, but I don't even bother enlisting them. I feel like I've just been going round in circles in treatment for the past 6 years, and sitting in a park or listening to calming music isn't going to give me a life back.
>
> It is okay to allow yourself to feel defeated. Although entirely justified, it is still only a feeling. It does not mean that you are truly defeated. It just feels that way for the moment. The feelings will eventually subside. If you have indeed been defeated in your latest battle, there is still the war to be fought. If you win the war, life will become nirvana for you. It is worth fighting for. Your exhaustion will be replaced by enthusiasm.
>
> "The measure of achievement lies not in how high the mountain,
> but in how hard the climb.
>
> The measure of success lies only in how high one feels he must
> climb to get there."
>
> These are my words. They were meant for me. I wrote them at least 15 years ago as I struggled with my lack of success as it is usually defined. I need to be reminded of them every now and then. It is a hell of an achievement that you are still alive. However, you have achieved so much more than just survive. I'll let you make a list.
>
> This has been a rather rambling message. I hope some part of it makes sense.
>
>
>
> - ScottSLS, Could you please provide details on your experience with Prazosin? specifically it's effect on your depression and its suspected mechanism of action. I looked it up and noticed it was an alpha blocker. I was previously on beta blockers (atenolol and propranolol) and am thinking of going back to one (if I fail to have any progress with Buspar.) What are the advantages in choosing an alpha blocker over a beta-blocker?
Posted by SLS on December 27, 2012, at 14:18:03
In reply to Re: feel finished » SLS, posted by schleprock on December 27, 2012, at 12:58:26
Hi schleprock.
> SLS, Could you please provide details on your experience with Prazosin? specifically it's effect on your depression and its suspected mechanism of action. I looked it up and noticed it was an alpha blocker. I was previously on beta blockers (atenolol and propranolol) and am thinking of going back to one (if I fail to have any progress with Buspar.) What are the advantages in choosing an alpha blocker over a beta-blocker?
First of all, it is important to note that I was taking 5 other drugs before adding the prazosin. However, in studies of PTSD, prazosin monotherapy produced improvements in anxiety and depression. For me, prazosin feels like a very clean, robust, and broad-spectrum antidepressant. It reduces the severity of the entire scope of depressive symptoms. The one exception to this is sexual libido. Reduced libido is a side effect of prazosin, and it showed up immediately. However, the resolution of depression helps to offset this, as depression pretty much wiped-out my sex-drive to begin with.
NE alpha receptors and NE beta receptors are not interchangeable. Although they can both function as sympatholytics, they are not evenly distributed in the brain, and serve different circuits. Although three subtypes of receptor exist, my guess is that it is the NE alpha-1b receptors that are critical in modulating mood. Prazosin is more potent here than are other NE alpha receptor antagonists.
I am playing with the idea that blocking these receptors in the brain structure known as Brodmanns Area 25 produces antidepressant effects similar to deep brain stimulation (DBS), which seems to work by interfering (reducing) neurotransmission there. In addition, NE alpha-1b receptors exist in the amygdala, an area known to be responsible for producing fear and anxiety. They also exist in the nucleus accumbens, where they seem to antagonize incoming glutamatergic circuits. This would most likely result in an increase in dopaminergic activity there via disinhibition. There really isn't very much research into the pharmacological actions of prazosin to reduce PTSD and depression. I am left to offer only a lot of guesses.
Prazosin - NE alpha-1a/b/d receptor antagonist.
1. Reduce hyperactivity in Brodmann Area 25 (anterior subgenual cingulate).
2. Reduce hyperactivity in amygdala.
3. Increase dopaminergic activity in the nucleus accumbens.
You might want to check out the following thread. It is rather long, but might be worth a look. Here is a relevant post:
http://www.dr-bob.org/babble/20120202/msgs/1009565.html
To be honest with you, I haven't researched this thing very much. Nowadays, I am interested in doing the minimum amount of research that will facilitate my getting well.
- Scott
Posted by jono_in_adelaide on December 27, 2012, at 16:40:56
In reply to Re: feel finished » schleprock, posted by SLS on December 27, 2012, at 14:18:03
Sorry if my comments about side effects came across as me having a dig, it wasnt intended that way..... its just that you often get the side effects before you get any of the improvement, and its easy to say "this stiff is crap" and stop it.
I'd consider either a high dose SSRI (Sertaline 200mg/day) or Effexor 300mg plus mirtazapine to help with the depression, OCD and anxiety, with or without a benzo
other options are the parnate + nortriptyline i mentioned earlier with a benzo, or Nardil plus nortriptyline and a benzo, or a high dose SSRI with bupropion and a benzo, all of course depending on what you've tried in the past
Which drug or combination of drugs has come closest to giving you relief?
Posted by jono_in_adelaide on December 27, 2012, at 16:42:33
In reply to Re: feel finished » schleprock, posted by SLS on December 27, 2012, at 14:18:03
If you havent tried clomipramine 150mg per day plus a benzo, try it!
Clomipramine has more side effects than the SSRI's, but it is generaly the gold standard for OCD, is very effective in depression, and also is good for anxiety
Posted by SLS on December 27, 2012, at 17:07:43
In reply to Re: feel finished GGG oh, also, posted by jono_in_adelaide on December 27, 2012, at 16:42:33
> If you havent tried clomipramine 150mg per day plus a benzo, try it!
>
> Clomipramine has more side effects than the SSRI's, but it is generaly the gold standard for OCD, is very effective in depression, and also is good for anxietyThat's a great suggestion.
- Scott
Posted by schleprock on December 27, 2012, at 18:54:42
In reply to Re: feel finished » schleprock, posted by SLS on December 27, 2012, at 14:18:03
> Hi schleprock.
>
> > SLS, Could you please provide details on your experience with Prazosin? specifically it's effect on your depression and its suspected mechanism of action. I looked it up and noticed it was an alpha blocker. I was previously on beta blockers (atenolol and propranolol) and am thinking of going back to one (if I fail to have any progress with Buspar.) What are the advantages in choosing an alpha blocker over a beta-blocker?
>
> First of all, it is important to note that I was taking 5 other drugs before adding the prazosin. However, in studies of PTSD, prazosin monotherapy produced improvements in anxiety and depression. For me, prazosin feels like a very clean, robust, and broad-spectrum antidepressant. It reduces the severity of the entire scope of depressive symptoms. The one exception to this is sexual libido. Reduced libido is a side effect of prazosin, and it showed up immediately. However, the resolution of depression helps to offset this, as depression pretty much wiped-out my sex-drive to begin with.
>
> NE alpha receptors and NE beta receptors are not interchangeable. Although they can both function as sympatholytics, they are not evenly distributed in the brain, and serve different circuits. Although three subtypes of receptor exist, my guess is that it is the NE alpha-1b receptors that are critical in modulating mood. Prazosin is more potent here than are other NE alpha receptor antagonists.
>
> I am playing with the idea that blocking these receptors in the brain structure known as Brodmanns Area 25 produces antidepressant effects similar to deep brain stimulation (DBS), which seems to work by interfering (reducing) neurotransmission there. In addition, NE alpha-1b receptors exist in the amygdala, an area known to be responsible for producing fear and anxiety. They also exist in the nucleus accumbens, where they seem to antagonize incoming glutamatergic circuits. This would most likely result in an increase in dopaminergic activity there via disinhibition. There really isn't very much research into the pharmacological actions of prazosin to reduce PTSD and depression. I am left to offer only a lot of guesses.
>
> Prazosin - NE alpha-1a/b/d receptor antagonist.
>
> 1. Reduce hyperactivity in Brodmann Area 25 (anterior subgenual cingulate).
>
> 2. Reduce hyperactivity in amygdala.
>
> 3. Increase dopaminergic activity in the nucleus accumbens.
>
> You might want to check out the following thread. It is rather long, but might be worth a look. Here is a relevant post:
>
> http://www.dr-bob.org/babble/20120202/msgs/1009565.html
>
> To be honest with you, I haven't researched this thing very much. Nowadays, I am interested in doing the minimum amount of research that will facilitate my getting well.
>
>
> - ScottThanks SLS. Found this article:
http://www.ehow.com/facts_5695241_alpha-blocker-vs_-beta-blocker.html
So basically one class lowers norepinephrine while one lowers epinephrine. The article manages to make the side-effects of Alphas sound much worse than Betas. Atenolol (not over 12.5 mg) I know I've been able to tolerate. Not sure what to do...
Do you also believe bet blockers to be an effective adjunct treatment for anxiety\depression, or only alpha blockers?
Posted by g_g_g_unit on December 27, 2012, at 19:21:18
In reply to Re: feel finished - GGG, posted by jono_in_adelaide on December 27, 2012, at 16:40:56
> Sorry if my comments about side effects came across as me having a dig, it wasnt intended that way..... its just that you often get the side effects before you get any of the improvement, and its easy to say "this stiff is crap" and stop it.
>
> I'd consider either a high dose SSRI (Sertaline 200mg/day) or Effexor 300mg plus mirtazapine to help with the depression, OCD and anxiety, with or without a benzo
>
> other options are the parnate + nortriptyline i mentioned earlier with a benzo, or Nardil plus nortriptyline and a benzo, or a high dose SSRI with bupropion and a benzo, all of course depending on what you've tried in the past
>
> Which drug or combination of drugs has come closest to giving you relief?Unfortunately, I found nortriptyline stimulating rather than sedating, so don't think I'd be able to tolerate it with an MAOI. Same thing with clomipramine -- it produced a lot of akathisia and agitation and isn't something I'd be desperate to revisit.
As I said, the closest I came to relief was on Parnate, which helped my depressive symptoms (anergia, lack of motivation, rejection sensitivity) and, to a degree, my ADD (which no other AD has done), but which didn't relieve my anxiety, and in fact may have increased it. I was only permitted to try up to 60mg, which was the minimum dose necessary for an anti-depressant response. Nardil helped too, but the insomnia was terrible and it made me a little hypomanic.
Posted by SLS on December 27, 2012, at 20:29:37
In reply to Re: feel finished - GGG » jono_in_adelaide, posted by g_g_g_unit on December 27, 2012, at 19:21:18
> Nardil helped too, but the insomnia was terrible and it made me a little hypomanic.
Perhaps you could combine Nardil with a stimulant and Klonopin. Nardil is the ideal MAOI for your depression and anxiety. The stimulant would help with depression and ADD. The Klonopin would help with anxiety, insomnia, and possibly mania. The mania from Nardil usually starts early in treatment and is self-limiting. Trileptal can be used as a mood stabilizer if necessary. If insomnia is an obstacle to feeling great on Nardil, then it is incumbent on your doctor to treat that insomnia aggressively as if it were your primary illness. Failure is not an option. Use Halcion along with another benzodiazepine if you have to. Perhaps 25 - 50 mg of Seroquel? Find a way.
If I recall, you have problems with antipsychotics? Saphris and Latuda are interesting drugs. Saphris can actually be energizing along with being anxiolytic.
- Scott
Posted by jono_in_adelaide on December 27, 2012, at 20:37:44
In reply to Re: feel finished - GGG » jono_in_adelaide, posted by g_g_g_unit on December 27, 2012, at 19:21:18
In that case, it looks like your best options are either Nardil + a mood stabaliser and maybe doxepin or a benzo for sleep, or Parnate (perhaps in a higher doseage) plus a benzo for anxiety.
I'd decide which one you prefered, and push the envelope so far as dose and combinations go
What exactly do you mean by "a bit hypomanic", just more energy than usual, or somthing more serious?
Parnate (perhaps at 80mg) plus a long acting benzo such as Valium
or
Nardil plus a mood stabaliser (your guess is as good as mine here) plus either a benzo or doxepin for sleep
Dont give up, keep tryimg, keep hope
> > Sorry if my comments about side effects came across as me having a dig, it wasnt intended that way..... its just that you often get the side effects before you get any of the improvement, and its easy to say "this stiff is crap" and stop it.
> >
> > I'd consider either a high dose SSRI (Sertaline 200mg/day) or Effexor 300mg plus mirtazapine to help with the depression, OCD and anxiety, with or without a benzo
> >
> > other options are the parnate + nortriptyline i mentioned earlier with a benzo, or Nardil plus nortriptyline and a benzo, or a high dose SSRI with bupropion and a benzo, all of course depending on what you've tried in the past
> >
> > Which drug or combination of drugs has come closest to giving you relief?
>
> Unfortunately, I found nortriptyline stimulating rather than sedating, so don't think I'd be able to tolerate it with an MAOI. Same thing with clomipramine -- it produced a lot of akathisia and agitation and isn't something I'd be desperate to revisit.
>
> As I said, the closest I came to relief was on Parnate, which helped my depressive symptoms (anergia, lack of motivation, rejection sensitivity) and, to a degree, my ADD (which no other AD has done), but which didn't relieve my anxiety, and in fact may have increased it. I was only permitted to try up to 60mg, which was the minimum dose necessary for an anti-depressant response. Nardil helped too, but the insomnia was terrible and it made me a little hypomanic.
>
>
>
Posted by brynb on December 27, 2012, at 20:49:03
In reply to Re: feel finished GGG oh, also, posted by jono_in_adelaide on December 27, 2012, at 16:42:33
> If you havent tried clomipramine 150mg per day plus a benzo, try it!
>
> Clomipramine has more side effects than the SSRI's, but it is generaly the gold standard for OCD, is very effective in depression, and also is good for anxietyJono & Scott,
I feel like this could be helpful for me, too. (Sorry to make this about me, but I'm very curious.) I need something that obliterates (ok, rids) the depression and anxiety. I mentioned in a thread below that I'm contemplating Nardil (or an MAOI) cause nothing's cutting it and I've been back in bed without showering for the past week again.
OR, are there other SRIs that could be more effective than Lexapro? I've been on it forever and like how clean it is with serotonin and that it's weight neutral. What's with Viibryd and Pristiq?
I tend to get a lot more anxious and activated from meds that work on norepinephrine as well as Wellburin.
Thanks.
-b
Posted by SLS on December 27, 2012, at 20:50:54
In reply to Re: feel finished » SLS, posted by schleprock on December 27, 2012, at 18:54:42
> Thanks SLS. Found this article:
>
> http://www.ehow.com/facts_5695241_alpha-blocker-vs_-beta-blocker.html
>
> So basically one class lowers norepinephrine while one lowers epinephrine. The article manages to make the side-effects of Alphas sound much worse than Betas. Atenolol (not over 12.5 mg) I know I've been able to tolerate. Not sure what to do...
>
> Do you also believe bet blockers to be an effective adjunct treatment for anxiety\depression, or only alpha blockers?
Beta blockers seem to help some people with anxiety, but it is not as effective for PTSD and depression as is prazosin.As an analogy, think of beta blockers as working on norepinephrine and prazosin as working on serotonin and dopamine. They are totally different in the way they act in the brain.
Prazosin is generally benign. If beta blockers have not worked magic for you, I would consider trying prazosin. To minimize startup side effects, begin at 1 mg at night. You might feel somewhat dizzy and somnolent in the beginning, but these things usually disappear entirely. Studies using prazosin for PTSD with depression have used, on the average, 6 - 12 mg/day. You need to take prazosin 2 - 3 times a day. Right now, aside from the libido thing, I would never know that I was taking prazosin.
- Scott
Posted by jono_in_adelaide on December 27, 2012, at 21:22:30
In reply to @ jono + SLS, posted by brynb on December 27, 2012, at 20:49:03
Clomipramine would certainly be worth trying, as would nardil, with or without a benzo. hard to say which would be best as its so individual. neither is weight neutral, but given your current condition, I think you need an effective drug, regardless of weight gain etc.
Speak to your psych and see which one s/he thisnk would be best, its obvious that what you're doing now isnt cutting it.
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