![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by ash on August 31, 2000, at 0:06:24
Hi all,
Like many folks here, I am one of those treatment resistant depressives who is looking for the magic medication(s) that will be the answer to my moderate/severe unipolar depression that has persisted for 15 plus years.
During the course of the last year, my Pdoc has experimented with a heavy-duty kind of polypharmacy. Basically, she kept on adding a new A/D to whatever else I was taking so that most recently I was on a combination of:
200 mg Zoloft, 350 mg Wellbutrin SR, 45 mg Remeron, 30 mg Ritalin, 5 mg Olanzapine plus T3 and T4 for hypothyroidism.
I suppose what she was hoping was to hit all neurotransmitters and receptors in as many ways as possible. As far as my depression was concerned though I might as well as have been taking sugar pills for all the good this cocktail did for me.
She was about to add Lamictal to the mix but on second thoughts decided that the dangers of a severe interaction were too high. She asked me to stop all my current meds first, to clean out my system so to speak.
I stopped everything cold turkey, that is went from full dose one day to zero the next. For about 3 days I was quite a bit more tired and sleepy than usual; but soon thereafter I was about 80% or so back to what was “normal” for me when I was taking all the antidepressants– anhedonia, lack of energy, a kind of blah existence but nevertheless able to sort of muddle through the day.
I guess what I am looking for is comments on this kind of polypharmacy or augmentation or whatever else it could be called. I am also curious if anything can be deduced from the fact that I had nowhere near the severe discontinuance effects that so many complain about even when they try to taper off the A/D’s
Posted by stjames on August 31, 2000, at 0:20:48
In reply to Polypharmacy, posted by ash on August 31, 2000, at 0:06:24
Has anything ever worked even just a little ? Any side effects
worth mentioning ? Have you tried MAOI's or Lith ? Stims other than
Ritalin ? Effexor ? Any Signicicant trama in your chilldhood ?James
Posted by ash on August 31, 2000, at 0:52:56
In reply to Re: Polypharmacy, posted by stjames on August 31, 2000, at 0:20:48
> Has anything ever worked even just a little ? Any side effects
> worth mentioning ? Have you tried MAOI's or Lith ? Stims other than
> Ritalin ? Effexor ? Any Signicicant trama in your chilldhood ?
>
> James
James,Here are the answers to your questions:
1. As far as the depression goes, I would have to say that probably nothing has worked. Fatigue or energy wise, perhaps the best I can say is that maybe the Ritalin helped 10-20%.
Ritalin is the only psychostimulant I have tried. By the way, it was no problem for me to have a nap after taking my midday 10mg dose of Ritalin.
2. Side effects have been mostly transient. By far the most common are increased sedation and even more fatigue. To a lesser extent, many medications cause me to have an overactive bladder so that I may be getting up every hour at night to rush to the bathroom (lithium was among the worst in this regard).
3 Some years back tried Parnate and Nardil, even in combination with TCA's.
4. Have also tried 300 mg Effexor, along with Serzone 450 mg, and Buspar ( another polypharmacy regimen I was on).
5. No childhood traumas or the like. I would consider my childhood as quite happy.
Thanks for your interest, James
Posted by JohnL on August 31, 2000, at 5:15:06
In reply to Polypharmacy, posted by ash on August 31, 2000, at 0:06:24
Just a gut instinct...
You could maybe order some Adrafinil and Amisulpride. Try them one at a time or, as I've discovered, combine them.
I offer this suggestion because I too suffered from the same anhedonic type depression you so accurately described. And like you, none of the available meds in any kind of combination worked very well, and often just made me worse or made me numb or made me a walking reservoir of side effects. I've been on as many as 5 or 7 meds at the same time, including all of the ones you mentioned.
Adrafinil worked somewhat on my anhedonia. Amisulpride did too. Both give you a different feeling however. But when the two are combined, the end result is so much more than the sum of the two added together. I turned to overseas meds after being totally frustrated with the slow and fruitless procedures of USA psychiatrists. In some ways I think they are seriously handicapped by not using some of the other meds from around the world. Some of those meds are far superior to anything we have in the USA.
For me anyway, the ONLY meds in the WORLD that really worked on my stubborn longterm anhedonia are Adrafinil+Amisulpride. And side effects are practically zero. For that reason, I offer the suggestion that you try this too. Overseas ordering is kind of uncomfortable at first, but that becomes routine and miniscule in comparison to how well you might end up feeling. If after all this there is no progress, then you can always at any time go back to your psychiatrist and pick up where you left off. Hopefully though, that will be a bridge you never have to cross again. :-)
Your depression and mine sound very much alike. Adrafinil+Amisulpride is worth considering, since it has been so successful for me. I would not be suggesting this if your depression was of a different type. But when prominent anhedonia is involved, I know what works and what doesn't. I do not know any drug your psychiatrist could prescribe that will work for your symptoms. But I do know of two European drugs prescribed by European doctors that could very well work. The cool thing is, you don't need to actually go to Europe and you don't need to see a doctor. You've been around meds long enough to know how to be able to manage this with or without a doctor's blessings.
John
Posted by Cindy W on August 31, 2000, at 9:39:50
In reply to Re: Polypharmacy, posted by ash on August 31, 2000, at 0:52:56
> > Has anything ever worked even just a little ? Any side effects
> > worth mentioning ? Have you tried MAOI's or Lith ? Stims other than
> > Ritalin ? Effexor ? Any Signicicant trama in your chilldhood ?
> >
> > James
>
>
> James,
>
> Here are the answers to your questions:
>
> 1. As far as the depression goes, I would have to say that probably nothing has worked. Fatigue or energy wise, perhaps the best I can say is that maybe the Ritalin helped 10-20%.
>
> Ritalin is the only psychostimulant I have tried. By the way, it was no problem for me to have a nap after taking my midday 10mg dose of Ritalin.
>
> 2. Side effects have been mostly transient. By far the most common are increased sedation and even more fatigue. To a lesser extent, many medications cause me to have an overactive bladder so that I may be getting up every hour at night to rush to the bathroom (lithium was among the worst in this regard).
>
> 3 Some years back tried Parnate and Nardil, even in combination with TCA's.
>
> 4. Have also tried 300 mg Effexor, along with Serzone 450 mg, and Buspar ( another polypharmacy regimen I was on).
>
> 5. No childhood traumas or the like. I would consider my childhood as quite happy.
>
> Thanks for your interest, James
Ash, when you took 300 mg Effexor and 450 mg of Serzone, how did that work? I've been trying to get my pdoc to combine the two, since those two seem to help me the most. Currently, I take 375 mg/day of Effexor-XR and 50 mg/night of Serzone. Thanks!--Cindy W
Posted by ash on August 31, 2000, at 10:26:57
In reply to Re: Polypharmacy, posted by JohnL on August 31, 2000, at 5:15:06
JohnL,
As a long term lurker who has been reading your threads, I know the Amisulpiride(AS)/Adrafanil
combo has been a true miracle for you. It is also on my short list of things to try next. My recent augmentation with the atypical antipsychotic Olanzapine(OL) was motivated to a large extent by your reported success with AS. OL hits all tbe D1 through D4 dopamine receptors whereas AS is more targeted towards the D2-D3.Cindy,
Like so many others, the Effexor/Serzone combo was ineffective for me. But as you may have surmised, I am very definitely atypical (weird?)in terms of how I react to A/D's.
I'd like to add one more thing about the sedating A/D's (Serzone, Remeron, Trazadone) and A/P's (Olanzapine). Serzone supposedly will help normalize one's sleep architecture, and I tried it for quite a while since my lab sleep studies have shown that I get zero Slow Wave Sleep (SWS, Stages 3 and 4 NREM). In a recent paper, Olanzapine was shown to increase SWS by 50 to 75% in healthy volunteers after just one night of dosing in the 5-10 mg range. Cindy, as you may be aware, lack of restful SWS is strongly implicated in the etiology of fibromylagia(FMS) and myofascial pain syndromes. So you might consider playing around with the dosages of Serzone and/or Olanzapine if you have FMS.
> Just a gut instinct...
>
> You could maybe order some Adrafinil and Amisulpride. Try them one at a time or, as I've discovered, combine them.
>
> I offer this suggestion because I too suffered from the same anhedonic type depression you so accurately described. And like you, none of the available meds in any kind of combination worked very well, and often just made me worse or made me numb or made me a walking reservoir of side effects. I've been on as many as 5 or 7 meds at the same time, including all of the ones you mentioned.
>
> Adrafinil worked somewhat on my anhedonia. Amisulpride did too. Both give you a different feeling however. But when the two are combined, the end result is so much more than the sum of the two added together. I turned to overseas meds after being totally frustrated with the slow and fruitless procedures of USA psychiatrists. In some ways I think they are seriously handicapped by not using some of the other meds from around the world. Some of those meds are far superior to anything we have in the USA.
>
> For me anyway, the ONLY meds in the WORLD that really worked on my stubborn longterm anhedonia are Adrafinil+Amisulpride. And side effects are practically zero. For that reason, I offer the suggestion that you try this too. Overseas ordering is kind of uncomfortable at first, but that becomes routine and miniscule in comparison to how well you might end up feeling. If after all this there is no progress, then you can always at any time go back to your psychiatrist and pick up where you left off. Hopefully though, that will be a bridge you never have to cross again. :-)
>
> Your depression and mine sound very much alike. Adrafinil+Amisulpride is worth considering, since it has been so successful for me. I would not be suggesting this if your depression was of a different type. But when prominent anhedonia is involved, I know what works and what doesn't. I do not know any drug your psychiatrist could prescribe that will work for your symptoms. But I do know of two European drugs prescribed by European doctors that could very well work. The cool thing is, you don't need to actually go to Europe and you don't need to see a doctor. You've been around meds long enough to know how to be able to manage this with or without a doctor's blessings.
> John
Posted by CarolAnn on August 31, 2000, at 14:31:20
In reply to Polypharmacy, posted by ash on August 31, 2000, at 0:06:43
Hey ash, boy I could have written the exact same post! I switched doctors while on four anti-depressants, and the new guy was horrified at so many being mixed. Currently, I'm on 400mgs./day Wellbutrin and 40mgs./day Celexa, they haven't helped much, but I have reached a point where I'm so tired of trying things that I've just stayed here for the past 8 months. Now, I also tried Ritalin and got no help from that at all, like you, I could nap right after my dose. My new doctor has me on Adderall and it has been a big help, especially in the first couple months. That's really why I'm writing, to suggest that at least, for the time being, you might want to switch from Ritalin to Adderall. But don't be surprised when the Adderall starts to lose effectiveness, it doesn't for everyone, but your symptoms are just like mine, so you might have the same experience. I've just tried Modafinil and didn't get much help from it. The next thing for me, I think is ordering some Adrafinil. Although, it is going to be a huge hassle, 'cause my husband is not going to approve (he is too moral).
Oh, I have also had no withdrawal symptoms at all with any of the drugs I've been on, and the only adverse side effect was with drugs that made me even more tired then I constantly am. I really do wonder if a lot of people who are helped dramatically by drugs are having some kind of placibo effect. I wish I was the type of person who can be affected by a placibo(have I spelled that right?), unfortunatly, not only do I have to have real medicine, I usually need twice as much as anyone else to feel anything at all!
Well, good luck! I'd love to hear how things go with your meds. CarolAnn
Posted by CraigF on August 31, 2000, at 16:57:11
In reply to Re: Polypharmacy » ash, posted by CarolAnn on August 31, 2000, at 14:31:20
CarolAnn,
Hello. I've caught up with you again on the medication. I finally decided to ditch the Serzone for Celexa (I'm at 40 mgs after four weeks and still hoping for better results). Weening of the Serzone slowly, and when it is done, I hope to add WB again (it made me angry and hard to focus last time, but I think that was in combo with Serzone metabolites)
How did you find it with the Celexa? The Celexa is making me sleepy and always hungry. Hoping to reverse that and sex problems with WB, but I fear losing concentration again. I'm thinking of asking for adderall too, with many ADD symptoms, but I don't want to continue stacking meds. How are you feeling currently?
Craig
Posted by CarolAnn on August 31, 2000, at 17:36:33
In reply to Re: Polypharmacy » CarolAnn, posted by CraigF on August 31, 2000, at 16:57:11
Hey Craig, it's nice to talk to you again! My situation is slightly different, because I was on Wellbutrin first, then added Celexa. They do seem to balance each other well as far as side-effects go. I would not say that I am 'well', but I am noticeably 'better' then with any other combo I had tried. I would eventually like to try Reboxetine(if it ever gets approved), because even though my moods are stable, I still don't really experience 'happiness'. Adderall was great stuff for me in the beginning. I felt the way that I imagine 'normal' people feel. Not giddy or 'high' just energetic, motivated, and hopeful. Unfortunatly, after a couple months, it started to lose effectiveness. Now, well, I'm better with it then without it, but I don't have really noticeable improvement like in the beginning. I definitly recommend that you try it though, most people who take it don't find that it poops out, and even if that happens to you, at least, you'll have had a couple of 'really' good months! Good luck, I'd love to hear how it goes. CarolAnn
Posted by noa on August 31, 2000, at 17:52:52
In reply to Re: Polypharmacy, posted by ash on August 31, 2000, at 15:36:57
Ash,
I am curious, did you also discontinue your thyroid meds, and what effect have they had on your lab tests?
One thing to consider is whether your hypothyroid is UNDERtreated. I was taking both cytomel and synthroid for a long time and still having difficulty getting my depression and fatigue under control. Finally, my pdoc suggested, and this was confirmed by an endo (I finally consulted an endo), that we needed to address the hypothyroid much more aggressively. Doing so has made THE difference. I only started to feel better after my TSH was suppressed by increasing my synthroid and splitting my cytomel dose.
Posted by stjames on August 31, 2000, at 22:45:00
In reply to Re: Polypharmacy, posted by ash on August 31, 2000, at 0:52:56
> 5. No childhood traumas or the like. I would consider my childhood as quite happy.
>
> Thanks for your interest, JamesJames here....
Glad to hear it ! Thanks for giving such good feedback.
Since Ritalin did something trying the other stims might
be worth it. Dexadrine and Adderal, true amphetamines,
do have AD effects and in some work as monotherapy.
Dex would be my choice, it's cheaper and is not very different
from Adderal.While agressive, I liked your doc's idea of using
a go for broke approch as a last ditch effort. In really seems
like noradrenilin and 5 HT are not the issue. It's time to go off
the map. Antisezure meds are used in mood problems. Antipsycotics
have antidepressant effects. The newer ones have a better side effect profile.
Other people on the list know more than i do about "off the map' stuff.If I were 15 yrs, trying everything (I'm impressed, when people say they have taken "everything"
few really have. Congradulations you qualify. ) for depression with no help, I would
question if the right condition was being treated. Do I have a different psyco condition ?
My depression could be secondary to a physical condition. Databases exist that list every
known cause for a given condition and frequency. A consult with a internist for lots o tests
is the next step. Sleep studies for aphnia and other info would be useful. But that is me.Noa is right about the thyriod. Get another consult with an endo. There are few things
more complex that neurology, endo is one of them.
I hope you are doing some therapy. The weight of 15
yrs of depression has got to create a lot of guilt and other issues.Please keep in touch with us.
james
Posted by Sigolene on September 1, 2000, at 7:43:41
In reply to Re: Polypharmacy, posted by JohnL on August 31, 2000, at 5:15:06
Hi Jhon,
Just a little question.
which dose of amisulpride do you take ?
What's that adrafinil, can't find it. what is the substance, is it acting on NE or 5 HT or both ?
Can you get all these meds by "anti aging systems"?
Thanks
SIgolene
> Just a gut instinct...
>
> You could maybe order some Adrafinil and Amisulpride. Try them one at a time or, as I've discovered, combine them.
>
> I offer this suggestion because I too suffered from the same anhedonic type depression you so accurately described. And like you, none of the available meds in any kind of combination worked very well, and often just made me worse or made me numb or made me a walking reservoir of side effects. I've been on as many as 5 or 7 meds at the same time, including all of the ones you mentioned.
>
> Adrafinil worked somewhat on my anhedonia. Amisulpride did too. Both give you a different feeling however. But when the two are combined, the end result is so much more than the sum of the two added together. I turned to overseas meds after being totally frustrated with the slow and fruitless procedures of USA psychiatrists. In some ways I think they are seriously handicapped by not using some of the other meds from around the world. Some of those meds are far superior to anything we have in the USA.
>
> For me anyway, the ONLY meds in the WORLD that really worked on my stubborn longterm anhedonia are Adrafinil+Amisulpride. And side effects are practically zero. For that reason, I offer the suggestion that you try this too. Overseas ordering is kind of uncomfortable at first, but that becomes routine and miniscule in comparison to how well you might end up feeling. If after all this there is no progress, then you can always at any time go back to your psychiatrist and pick up where you left off. Hopefully though, that will be a bridge you never have to cross again. :-)
>
> Your depression and mine sound very much alike. Adrafinil+Amisulpride is worth considering, since it has been so successful for me. I would not be suggesting this if your depression was of a different type. But when prominent anhedonia is involved, I know what works and what doesn't. I do not know any drug your psychiatrist could prescribe that will work for your symptoms. But I do know of two European drugs prescribed by European doctors that could very well work. The cool thing is, you don't need to actually go to Europe and you don't need to see a doctor. You've been around meds long enough to know how to be able to manage this with or without a doctor's blessings.
> John
Posted by Sigolene on September 1, 2000, at 8:01:36
In reply to Polypharmacy, posted by ash on August 31, 2000, at 0:06:24
Sometimes I feel my meds as if they were poison, especially when there is a long term silent side effect that i discover after mounths. For example a decrease of potassium or i don't remember what.
Then i decide to stop all of them. And it's like you, i feel the same with or without med at the beginning. But after a while i've noticed that at the first stress, contradiction, ... i fall again in deep depression for about 2 days. (i've got atypical depression). It's not the case when i take meds. So i think we can consider our medications more like a prevention, because we have a kind of "fragility".
Sigolene
> Hi all,
>
> Like many folks here, I am one of those treatment resistant depressives who is looking for the magic medication(s) that will be the answer to my moderate/severe unipolar depression that has persisted for 15 plus years.
>
> During the course of the last year, my Pdoc has experimented with a heavy-duty kind of polypharmacy. Basically, she kept on adding a new A/D to whatever else I was taking so that most recently I was on a combination of:
>
> 200 mg Zoloft, 350 mg Wellbutrin SR, 45 mg Remeron, 30 mg Ritalin, 5 mg Olanzapine plus T3 and T4 for hypothyroidism.
>
> I suppose what she was hoping was to hit all neurotransmitters and receptors in as many ways as possible. As far as my depression was concerned though I might as well as have been taking sugar pills for all the good this cocktail did for me.
>
> She was about to add Lamictal to the mix but on second thoughts decided that the dangers of a severe interaction were too high. She asked me to stop all my current meds first, to clean out my system so to speak.
>
> I stopped everything cold turkey, that is went from full dose one day to zero the next. For about 3 days I was quite a bit more tired and sleepy than usual; but soon thereafter I was about 80% or so back to what was “normal” for me when I was taking all the antidepressants– anhedonia, lack of energy, a kind of blah existence but nevertheless able to sort of muddle through the day.
>
> I guess what I am looking for is comments on this kind of polypharmacy or augmentation or whatever else it could be called. I am also curious if anything can be deduced from the fact that I had nowhere near the severe discontinuance effects that so many complain about even when they try to taper off the A/D’s
Posted by LucindaLinda on September 2, 2000, at 2:22:04
In reply to Re: Polypharmacy, posted by ash on August 31, 2000, at 10:26:57
> I'd like to add one more thing about the sedating A/D's (Serzone, Remeron, Trazadone) and A/P's (Olanzapine). Serzone supposedly will help normalize one's sleep architecture, and I tried it for quite a while since my lab sleep studies have shown that I get zero Slow Wave Sleep (SWS, Stages 3 and 4 NREM). In a recent paper, Olanzapine was shown to increase SWS by 50 to 75% in healthy volunteers after just one night of dosing in the 5-10 mg range. Cindy, as you may be aware, lack of restful SWS is strongly implicated in the etiology of fibromylagia(FMS) and myofascial pain syndromes. So you might consider playing around with the dosages of Serzone and/or Olanzapine if you have FMS.
I have FMS and tried Serzone along with doxepin and flexeril and began to wake up gasping for air and realized (after dreaming about it) that I had stopped breathing in my sleep. I discontinued the Serzone immediately and after doing some research found that Serzone repressing breathing in some people when combined with other drugs.
Would be interested in more information about getting my sleep patterns back to normal? so that I can get off the sleep meds.
Posted by stjames on September 2, 2000, at 15:50:40
In reply to Re: Polypharmacy, posted by LucindaLinda on September 2, 2000, at 2:22:04
> Would be interested in more information about getting my sleep patterns back to normal? so that I can get off the sleep meds.
James here.....
If it were me I would suspect existing sleep apnia made worse by a meds, and get a sleep study.
Sleep apnia is very common.james
Posted by ash on September 3, 2000, at 1:35:41
In reply to Re: Polypharmacy, posted by stjames on September 2, 2000, at 15:50:40
Carol Ann, Noa and James , Sigolene, LucindaLinda
Thanks for your feedback and suggestions.
Carol Ann,
I do intend to explore the other stimulants and thanks for describing your experience with Adderall. Reboxetine is another one I am waiting to try
I guess I am resigned to the fact that emotionally at least, I am unlikely to ever get over the “death warmed-over” kind of existence that has dogged me for so many years. But it would sure would be nice if through the use of stimulants or SNRI’s or whatever the “corpse” had at least some energy to shuffle around instead of being comatose most of the time.
Noa,
My mistake for not making it clear, I am continuing with my thyroid meds (.088mg Synthroid plus .025mg Cytomel) that were prescribed by my endocrinologist. I am fortunate to have him as he is the Chief of Medicine at the teaching hospital in San Francisco and consistently makes the list of “Best Doctors” in the State. Yes my TSH is being maintained close to zero and my free T3 and T4 are in the top 10% of the normal range. I was originally diagnosed with sub-clinical hypothyroidism with TSH at the top of the normal range but with very high thyroid antibodies (autoimmune thyroditis or Hashimoto’s disease). It is my understanding that there is a fairly close association between unipolar depression and Hashimoto’s.
BTW, I have read some recent German papers about successfully using supraphysiological augmentation doses of T4/T3, in the range of 250 to 500 mcg for treatment resistant depressives who were other otherwise euthyroid. My endo however wasn’t impressed with the studies indicating that they are being shortsighted and the long-term impacts of high exogenous thyroid could be quite dangerous.
James,
I know for a fact that I have sleep problems (a moderate amount of sleep apnea diagnosed through sleep studies but the docs are not sure if it is obstructive or central) so the classic chicken and egg question- if the sleep disorders are causing the depression or vice versa.
Sigolene,
I’ve been off A/D’s for over a week now and so far at least I would be hard pressed to stay that I am significantly worse than the time when I was popping a handful of pills every day.
LucindaLinda.
Serzone didn’t help my FMS symptoms either though I did not have the adverse breathing reaction you describe. For other FMS treatments, I guess you are familiar with the alt.med.fibromyalgia and related newsgroups. The current “Natural” drug favorite seems to be MSM. If you do a dejacom search for Olanzapine (Zyprexa) and FMS you should be able to get a few posts about some individuals whose FMS symptoms responded very favorably.
Best wishes to all.
Posted by stjames on September 3, 2000, at 2:57:00
In reply to Re: Polypharmacy, posted by ash on September 3, 2000, at 1:39:00
James,
I know for a fact that I have sleep problems (a moderate amount of sleep apnea diagnosed through sleep studies but the docs are not sure if it is obstructive or central) so the classic chicken and egg question- if the sleep disorders are causing the depression or vice versa.james here...
Do you use a CHAP machine at night ? It would be intresting to see what
would happen if you got enough O2 at night.james
Posted by noa on September 4, 2000, at 13:26:26
In reply to Re: Polypharmacy, posted by stjames on September 3, 2000, at 2:57:00
Yes, I think investigating the sleep aspect is worthwhile. There is also an association between hypothyroid and sleep apnea. With you, it may be that thresholds for various problems are lowered by the meds, or by one or another of the conditions.
A sleep study and trial of CPAP or BIPAP might help.
This is the end of the 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.