![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 51 to 75 of 76. Go back in thread:
Posted by Phillipa on December 27, 2012, at 21:51:08
In reply to Re: @ jono + SLS - brynb, posted by jono_in_adelaide on December 27, 2012, at 21:22:30
Bryn Jono is right it's getting this bad? Phillipa
Posted by brynb on December 27, 2012, at 23:35:40
In reply to Re: @ jono + SLS - brynb, posted by Phillipa on December 27, 2012, at 21:51:08
yes, it's bad--I've spent the week in bed. I can't even cry. I'm taking my Librium all day long to sleep. to make things worse, I lost my unemployment but gained two writing jobs, only I can't get myself to work on them even though I don't need to leave my apartment to do them!
I'm also pms-ing, which sends me into a tailspin. I don't want to quit & I have hope that things will get better but it seems so far away. I'm trying so hard to keep a brave face for my family but clearly when I'm holed up sleeping & not showering, it's a hard to maintain. my pdoc hasn't called me back & I think I'm going to embark upon the arduous task of finding someone new.
what's worse is I truly believe we create our own realities & that I could really push through this right now, BUT, I just don't have it in me at the moment. I have no strength right now.
Posted by g_g_g_unit on December 28, 2012, at 6:44:44
In reply to Re: feel finished - GGG » g_g_g_unit, posted by SLS on December 27, 2012, at 20:29:37
> > 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.
>
>
> - ScottThanks for the suggestions. Nardil + d-amphetamine is something I would love to try, but I have very little hope of having it prescribed. As I've mentioned before, I e-mailed a self-described specialist in treatment-resistant depression who claimed he was aware of studies indicating the usefulness of the combination, but considered it far too dangerous to utilize in practice.
There is a "professorial" unit at the hospital I would be going to, so I don't know if they would be more amenable to exotic treatment ideas, but the psychiatrist I contacted was also a professor at the same university with ties to the clinic.
As far as anti-psychotics go, Seroquel induced akathisia at the lowest possible doses (prescribed for sleep), Zyprexa and Risperdal increased anxiety.
Posted by g_g_g_unit on December 28, 2012, at 6:47:46
In reply to Re: feel finished - GGG, posted by jono_in_adelaide on December 27, 2012, at 20:37:44
> 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 goI suppose it would ultimately depend on how far the psychiatrist in question would be willing to push things. Liberal psychiatrists seem to be a rarity in Australia.
>
> What exactly do you mean by "a bit hypomanic", just more energy than usual, or somthing more serious?More energy, a little euphoric, acted slightly out-of-character (reconciled with brother I hadn't spoken to for 4 years, though perhaps that's a good thing?) ..
>
> 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
>My only worry is Nardil would have no benefit on ADD (most ADD patients seem to report in exacerbating their attentional difficulties).
> 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 SLS on December 28, 2012, at 7:11:39
In reply to Re: feel finished - GGG » SLS, posted by g_g_g_unit on December 28, 2012, at 6:44:44
> > > 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
>
> Thanks for the suggestions. Nardil + d-amphetamine is something I would love to try, but I have very little hope of having it prescribed. As I've mentioned before, I e-mailed a self-described specialist in treatment-resistant depression who claimed he was aware of studies indicating the usefulness of the combination, but considered it far too dangerous to utilize in practice.Perhaps he needs more practice?
Have you found and printed material indicating the safety of such combinations to show your doctors? Being on Parnate + TCA + stimulants hasn't killed me. I wish I had the name of a good doctor for you. Where do you live? Which universities are close to you? I might be able to come up with some names for you. Perhaps you can arrange for a consultation with another doctor who would then have a conversation with your current doctor?
Do you have the antipsychotic, asenapine (Saphris), there?
- Scott
Posted by g_g_g_unit on December 28, 2012, at 7:30:18
In reply to Re: feel finished - GGG » g_g_g_unit, posted by SLS on December 28, 2012, at 7:11:39
>
> Perhaps he needs more practice?I imagine so. I remember a comment from Chairman_MAO on here about how European-trained psychiatrists are far more willing to take risks, and that was the only way he managed to get an MAOI + stimulant prescribed. There is a Russian woman I saw when I first moved here who seemed extremely competent and well-researched, but she was so aggressive and confrontational that I found her impossible to work with. I've always imagined that she might be willing to try the combination, though I'm far too scared to return to her (I just left halfway through treatment and never returned).
>
> Have you found and printed material indicating the safety of such combinations to show your doctors?No, I didn't bother. It took an incredible amount of convincing to get my psychiatrist to exceed the daily threshold of 30mg of Parnate per day permitted here, so I doubt he would add a psychostimulant into the mix (plus Parnate was stimulating enough). That said, if I go inpatient, he won't be treating me.
>Being on Parnate + TCA + stimulants hasn't killed >me. I wish I had the name of a good doctor for >you. Where do you live? Which universities are >close to you? I might be able to come up with >some names for you. Perhaps you can arrange for a >consultation with another doctor who would then >have a conversation with your current doctor?
I live in Melbourne, Australia. We have Melbourne University, Monash University and Deaken University here. If you could come up with any names, that would be great. I have done my best -- emailing heads of departments etc. -- though typically I don't receive a response.
My psychiatrist did, at one point, refer me to a professor he frequently utilizes for second opinions. The doctor in question recommended a high dose SSRI + high dose anti-psychotic (despite my lackluster response to both) and said I couldn't possibly have ADD (though I don't know how he discerned that after a single one-hour interview). He also recommended ECT over MAOIs. I kind of lost faith in other specialists after that. My own psychiatrist has been extremely accommodating a pleasure to work with, but doesn't, I think, have the research background to toy with more exotic combinations. He tends to treat fairly straightforward ADHD cases, from my understanding. I stick with him for his patience and goodwill and unparalleled bedside manner.
>
> Do you have the antipsychotic, asenapine (Saphris), there?
>A cursory google search seems to suggest we do ..
>
> - ScottThanks, as always.
Posted by g_g_g_unit on December 29, 2012, at 1:41:32
In reply to Re: feel finished - GGG » g_g_g_unit, posted by SLS on December 28, 2012, at 7:11:39
Hey SLS, I'm not sure whether you'll be able to answer this or not, but I'm not currently on any meds -- and my psychiatrist only returns from vacation in three weeks -- so I kind of have some room to experiment.
Anyway, I have a bunch of Memantine lying around. I tried it in doses varying from 2.5 - 15mg, but found that it increased my anxiety/OCD and caused agitation.
I read a post from phiddipus stating that 5-HT3 affinity increases at 20mg, and thus it enhances GABA activity and becomes more anxiolytic. I can't find anything that confirms that and haven't read of anyone noticing a subjective difference in effect with different doses -- in fact, my adverse reaction seems to be quite out of the ordinary. Overall, from studies etc., it seems to be a really well-tolerated drug, which is why my response confused me.
That said, do you think it would be worth experimenting with taking 20mg a day for a little while and seeing how I respond? Do you know of many people who have experience with the drug and possibly responded better at a higher doses? Is it possible to speculate whether the increased NMDA antagonism etc. could possibly be more beneficial?
It's hard to know whether attempting to self-medicate when feeling so out-of-control etc. might be worse for me -- and whether it might be better to just secede control over to the hospital -- but I also thought I might get lucky (for once) and didn't have anything to lose, other than some transient discomfort.
Posted by SLS on December 29, 2012, at 7:44:17
In reply to question for SLS » SLS, posted by g_g_g_unit on December 29, 2012, at 1:41:32
I spent about an hour researching 5-HT3 receptors and am now more confused now than before I started. I had begun to write a long-winded explanation, but quickly found that the subject would require more study to offer any meaningful understanding at this time. 5-HT3 receptor function and dynamics are complex and variable, and depends upon the neuroal circuits they appear in and the species being studied.
As far as I can see, memantine acts as an antagonist of serotonin 5-HT3 receptors at concentrations comparable to those producing NMDA antagonism. However, any small difference in the numbers observed in the lab might translate to a significant difference in therapeutic dosage. Phiddipus might be right. I can't be sure. However, because memantine can help with OCD, I think this might be reason enough for you to try it again. I don't think you can evaluate memantine until you can establish a dosage of 20 mg/day. If anxiety prevents you from doing this, I would discontinue it. From what I gather, antagonism of 5-HT3 receptors in the amygdala can lead to a reduction in the activity of GABA neurons there. This might account for the anxiety you experience. It might dissipate with continued treatment, though, as I believe the presynaptic membrane becomes desensitized quickly. If it doesn't dissipate, this may be a clue into what is going on with you - amygdala hyperactivity. How do you react to Neurontin (gabapentin)? Perhaps prazosin would help.
What if you were to attack the ADD, anxiety, and OCD first? Do you think the depression would resolve?
As always, it would be nice to have your doctor support you during a treatment experiment. However, if it were me, I would probably try the memantine again and push the dosage to 20 mg/day or higher. Take things one step at a time, though. See if the startup anxiety is tolerable using the recommended titration schedule. If the inceased anxiety persists for two weeks or is otherwise intolerable, I would stop taking it. Your amygdala might be hyperactive. If you do manage to establish a dosage of 20 mg/day without adverse effects, you might as well leave it on board as you try adding Nardil, Viibryd, or clomipramine.
Nardil + Focalin + memantine might be interesting.
Recommended NAMENDA dosing schedule:Week 1: Starting on Day 1. Take one 5 mg tablet in the morning, each day.
Week 2: Starting on Day 8. Take one 5 mg tablet in the morning and one 5 mg tablet at night, each day.
Week 3: Starting on Day 15. Take one 10 mg tablet in the morning and one 5 mg tablet at night, each day.
Week 4: Starting on Day 22. Take one 10 mg tablet in the morning and one 10 mg tablet at night, each day.
- Scott
Posted by g_g_g_unit on December 29, 2012, at 21:46:10
In reply to Re: question for SLS » g_g_g_unit, posted by SLS on December 29, 2012, at 7:44:17
Thanks so much for your reply Scott.
For the record, I *did* recently try Memantine in a dose range from 2.5mg-15mg and only experienced an increase in anxiety and agitation. At 10mg, and again 15mg, I gave each dose two weeks to adjust, but the increased anxiety never dissipated, which is what forced me to discontinue.
I thought perhaps that 20mg might yield some alternate effects, so was considering just starting directly at 20mg without titrating, though if I reacted badly to lower doses, perhaps it isn't worth my time?
> I spent about an hour researching 5-HT3 receptors and am now more confused now than before I started. I had begun to write a long-winded explanation, but quickly found that the subject would require more study to offer any meaningful understanding at this time. 5-HT3 receptor function and dynamics are complex and variable, and depends upon the neuroal circuits they appear in and the species being studied.
>
> As far as I can see, memantine acts as an antagonist of serotonin 5-HT3 receptors at concentrations comparable to those producing NMDA antagonism. However, any small difference in the numbers observed in the lab might translate to a significant difference in therapeutic dosage. Phiddipus might be right. I can't be sure. However, because memantine can help with OCD, I think this might be reason enough for you to try it again. I don't think you can evaluate memantine until you can establish a dosage of 20 mg/day. If anxiety prevents you from doing this, I would discontinue it. From what I gather, antagonism of 5-HT3 receptors in the amygdala can lead to a reduction in the activity of GABA neurons there. This might account for the anxiety you experience. It might dissipate with continued treatment, though, as I believe the presynaptic membrane becomes desensitized quickly. If it doesn't dissipate, this may be a clue into what is going on with you - amygdala hyperactivity. How do you react to Neurontin (gabapentin)? Perhaps prazosin would help.
>
> What if you were to attack the ADD, anxiety, and OCD first? Do you think the depression would resolve?
>
> As always, it would be nice to have your doctor support you during a treatment experiment. However, if it were me, I would probably try the memantine again and push the dosage to 20 mg/day or higher. Take things one step at a time, though. See if the startup anxiety is tolerable using the recommended titration schedule. If the inceased anxiety persists for two weeks or is otherwise intolerable, I would stop taking it. Your amygdala might be hyperactive. If you do manage to establish a dosage of 20 mg/day without adverse effects, you might as well leave it on board as you try adding Nardil, Viibryd, or clomipramine.
>
> Nardil + Focalin + memantine might be interesting.
>
>
> Recommended NAMENDA dosing schedule:
>
> Week 1: Starting on Day 1. Take one 5 mg tablet in the morning, each day.
>
> Week 2: Starting on Day 8. Take one 5 mg tablet in the morning and one 5 mg tablet at night, each day.
>
> Week 3: Starting on Day 15. Take one 10 mg tablet in the morning and one 5 mg tablet at night, each day.
>
> Week 4: Starting on Day 22. Take one 10 mg tablet in the morning and one 10 mg tablet at night, each day.
>
>
> - Scott
Posted by SLS on December 29, 2012, at 22:24:58
In reply to Re: question for SLS » SLS, posted by g_g_g_unit on December 29, 2012, at 21:46:10
> I thought perhaps that 20mg might yield some alternate effects, so was considering just starting directly at 20mg without titrating, though if I reacted badly to lower doses, perhaps it isn't worth my time?
I had thought to suggest that you restart memantine at 20 mg/day so that you can test your idea. However, I am reluctant to encourage anyone else to try it under the premise that they would find the drug as tolerable as I did.
I once started memantine right at 20 mg/day. For me personally, I am not afraid of memantine, and would probably restart it at 20 mg/day again if I wanted to add it to my present treatment regime. The worst thing that I would anticipate happening is a transient feeling of brain-fog and perhaps drunkeness along with nausea and headache.
I am not aware of any dangerous reactions to 40 mg/day of memantine.
I guess I haven't really helped you out with this post.
Sorry.
- Scott
Posted by g_g_g_unit on December 30, 2012, at 1:11:07
In reply to Re: question for SLS » g_g_g_unit, posted by SLS on December 29, 2012, at 22:24:58
Hey Scott -- no that's okay, I suppose I'm really just looking for external license to experiment, whereas it should originate from me. I realize it's probably not possible for you to speculate on what 20mg will do based on my reaction to lower doses.
I think I'll skip the titration process and just try 20mg for at least a week or so. The worst I can expect is increased anxiety and agitation, in which case I'll stop.
> > I thought perhaps that 20mg might yield some alternate effects, so was considering just starting directly at 20mg without titrating, though if I reacted badly to lower doses, perhaps it isn't worth my time?
>
> I had thought to suggest that you restart memantine at 20 mg/day so that you can test your idea. However, I am reluctant to encourage anyone else to try it under the premise that they would find the drug as tolerable as I did.
>
> I once started memantine right at 20 mg/day. For me personally, I am not afraid of memantine, and would probably restart it at 20 mg/day again if I wanted to add it to my present treatment regime. The worst thing that I would anticipate happening is a transient feeling of brain-fog and perhaps drunkeness along with nausea and headache.
>
> I am not aware of any dangerous reactions to 40 mg/day of memantine.
>
> I guess I haven't really helped you out with this post.
>
> Sorry.
>
>
> - Scott
Posted by g_g_g_unit on December 30, 2012, at 1:17:03
In reply to Re: question for SLS » g_g_g_unit, posted by SLS on December 29, 2012, at 22:24:58
Hey Scott -- no that's okay, I suppose I'm really just looking for external license to experiment, whereas it should originate from me. I realize it's probably not possible for you to speculate on what 20mg will do based on my reaction to lower doses.
I think I'll skip the titration process and just try 20mg for at least a week or so. The worst I can expect is increased anxiety and agitation, in which case I'll stop.
> > I thought perhaps that 20mg might yield some alternate effects, so was considering just starting directly at 20mg without titrating, though if I reacted badly to lower doses, perhaps it isn't worth my time?
>
> I had thought to suggest that you restart memantine at 20 mg/day so that you can test your idea. However, I am reluctant to encourage anyone else to try it under the premise that they would find the drug as tolerable as I did.
>
> I once started memantine right at 20 mg/day. For me personally, I am not afraid of memantine, and would probably restart it at 20 mg/day again if I wanted to add it to my present treatment regime. The worst thing that I would anticipate happening is a transient feeling of brain-fog and perhaps drunkeness along with nausea and headache.
>
> I am not aware of any dangerous reactions to 40 mg/day of memantine.
>
> I guess I haven't really helped you out with this post.
>
> Sorry.
>
>
> - Scott
Posted by SLS on December 30, 2012, at 5:08:29
In reply to Re: question for SLS » SLS, posted by g_g_g_unit on December 30, 2012, at 1:17:03
> Hey Scott -- no that's okay, I suppose I'm really just looking for external license to experiment, whereas it should originate from me. I realize it's probably not possible for you to speculate on what 20mg will do based on my reaction to lower doses.
>
> I think I'll skip the titration process and just try 20mg for at least a week or so. The worst I can expect is increased anxiety and agitation, in which case I'll stop.I know what it is like to fear never knowing for sure whether or not a treatment idea would work. It would forever nag at you had you not tried this now.
Phiddipus was insistent that dosages above 20 mg/day worked magic.
Good luck.
- Scott
Posted by SLS on December 30, 2012, at 6:50:22
In reply to Re: question for SLS » SLS, posted by g_g_g_unit on December 30, 2012, at 1:17:03
I'll see if I can find more, but these doctors would be worth contacting - if not for a consultation, then you can ask them for some referrals:
----------------------------------------------
Berk, M
Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong, Victoria, Australia
----------------------------------------------
Dodd, S
Department of Clinical and Biomedical Sciences, University of Melbourne, Community and Mental Health, Barwon Health, Swanston Centre, Geelong, Victoria, Australia.
----------------------------------------------
- Scott
Posted by g_g_g_unit on December 30, 2012, at 7:17:19
In reply to Re: question for SLS » g_g_g_unit, posted by SLS on December 30, 2012, at 6:50:22
Wow Scott, thank you so much for that. Do you mind me asking how you came across their names?
Professor Berk is one of the psychiatrists I contacted who mentioned using doses of Parnate that exceed 60mg. Unfortunately, he failed to reply to my follow-up e-mail regarding referrals and I didn't want to pester him further, though when I called the clinic I was told he's currently overseas.
> I'll see if I can find more, but these doctors would be worth contacting - if not for a consultation, then you can ask them for some referrals:
>
> ----------------------------------------------
>
> Berk, M
>
> Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong, Victoria, Australia
>
> mikebe@barwonhealth.org.au
>
> ----------------------------------------------
>
> Dodd, S
>
> Department of Clinical and Biomedical Sciences, University of Melbourne, Community and Mental Health, Barwon Health, Swanston Centre, Geelong, Victoria, Australia.
>
> seetald@barwonhealth.org.au
>
> ----------------------------------------------
>
>
> - Scott
Posted by g_g_g_unit on December 30, 2012, at 7:23:03
In reply to Re: question for SLS » g_g_g_unit, posted by SLS on December 30, 2012, at 5:08:29
> I know what it is like to fear never knowing for sure whether or not a treatment idea would work. It would forever nag at you had you not tried this now.Yeah, you're right ..
>
> Phiddipus was insistent that dosages above 20 mg/day worked magic.Are you sure? The last post of his I could find on the matter suggested it did nothing for him in doses up to 40mg.
>
> Good luck.
>Thank you.
Posted by SLS on December 30, 2012, at 8:17:09
In reply to Re: question for SLS » SLS, posted by g_g_g_unit on December 30, 2012, at 7:23:03
> > Phiddipus was insistent that dosages above 20 mg/day worked magic.
> Are you sure?No.
Now that I have reviewed the archives, it seems that some people experienced more anxiety at 20 mg/day than they did at 15 mg/day. I tried 40 mg/day, but I didn't like how it affected me. I experienced some cognitive changes that reminded me of being intoxicated with alcohol or MJ. Other people report experiencing dissociation.
- Scott
Posted by SLS on December 30, 2012, at 8:18:39
In reply to Re: question for SLS » SLS, posted by g_g_g_unit on December 30, 2012, at 7:17:19
> Wow Scott, thank you so much for that. Do you mind me asking how you came across their names?
I found them on Medline/PubMed.
- Scott
Posted by elanor roosevelt on December 30, 2012, at 23:44:15
In reply to feel finished, posted by g_g_g_unit on December 26, 2012, at 7:48:12
The days are getting longer a little bit at a time. not a solution but perhaps a help.
no grooming, no exercise, junk food and no sense of future. These are symptoms--not who you are.
There are other meds that are not ssri's there are choices out there for you.
You are not at the end.
You're at the beginning.While you are figuring out your next step remember to take warm baths and to get out in the sun(not at the same time).
Hang in there
Posted by Meatwood_Flack on December 31, 2012, at 6:00:47
In reply to Re: feel finished, posted by elanor roosevelt on December 30, 2012, at 23:44:15
> The days are getting longer a little bit at a time. not a solution but perhaps a help.
>
> no grooming, no exercise, junk food and no sense of future. These are symptoms--not who you are.
>
> There are other meds that are not ssri's there are choices out there for you.
>
> You are not at the end.
> You're at the beginning.
>
> While you are figuring out your next step remember to take warm baths and to get out in the sun(not at the same time).
> Hang in thereGood advice...
Posted by SLS on December 31, 2012, at 7:20:59
In reply to Re: feel finished, posted by elanor roosevelt on December 30, 2012, at 23:44:15
Hi Elanor.
I hope you are in a good place these days.
> no grooming, no exercise, junk food and no sense of future. These are symptoms--not who you are.Wise.
I try to remember this every single day. Thinking this way becomes habit after awhile and helps protect my sense of self-esteem.
- Scott
Posted by g_g_g_unit on January 2, 2013, at 1:08:50
In reply to Re: feel finished » elanor roosevelt, posted by SLS on December 31, 2012, at 7:20:59
So I wrote to one of the psychiatrists, S. Dodd, giving him a short summation of my case and asking if he knew anyone in my area who worked with difficult/treatment-resistant cases. This was the incredibly helpful response I received:
Dear xxx,
I am a research academic in Geelong and do not treat patients. There are many excellent psychiatrists in Melbourne. Please organise to see someone there.
Kind regards,
Seetal
Posted by SLS on January 2, 2013, at 1:24:56
In reply to psychiatrist's response, posted by g_g_g_unit on January 2, 2013, at 1:08:50
> So I wrote to one of the psychiatrists, S. Dodd, giving him a short summation of my case and asking if he knew anyone in my area who worked with difficult/treatment-resistant cases. This was the incredibly helpful response I received:
>
> Dear xxx,
>
> I am a research academic in Geelong and do not treat patients. There are many excellent psychiatrists in Melbourne. Please organise to see someone there.
>
> Kind regards,
> Seetal
A$$hole.
- Scott
Posted by SLS on January 2, 2013, at 1:34:34
In reply to Re: psychiatrist's response » g_g_g_unit, posted by SLS on January 2, 2013, at 1:24:56
> > So I wrote to one of the psychiatrists, S. Dodd, giving him a short summation of my case and asking if he knew anyone in my area who worked with difficult/treatment-resistant cases. This was the incredibly helpful response I received:
> >
> > Dear xxx,
> >
> > I am a research academic in Geelong and do not treat patients. There are many excellent psychiatrists in Melbourne. Please organise to see someone there.
> >
> > Kind regards,
> > Seetal
>
>
> A$$hole.
>
>
> - Scott
Here:http://www.ncbi.nlm.nih.gov/pubmed?term=depressive%20disorder%20melbourne
Do some fishing...
- Scott
Posted by alchemy on January 3, 2013, at 21:01:00
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.
>
>
>
> - ScottScott, can I just say that you often have very insightful and caring advice? I think most people here respect your opinion and your knowledge on drugs as well. So at least know that your own experiences have helped many.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.