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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Mr. Scott on December 16, 2001, at 21:56:06
Hello friends and fellow sufferers,I am chronically depressed (the lethargic, rejection sensitive type), easily overstressed, and always anxious and obsessing. Every time I take an (ssri/Effexor)antidepressant I notice an immediate improvement in the rejection sensitvity, and the feeling of total helplessness, as well as the obsessing. At the same time I tend to get angry more easily, I feel agitated, I act "goofy" or giddy and immature even. Something definately happens along the lines or irritability and agitation that isn't right. At the same time that I feel physically & mentally agitated, my brain is eaasily dulled by ssri's (not so much Effexor)My face also swells which really bothers me.
My quality of life is truly depleted and it seems I can do nothing about it. I am watching the world and my life go by, and it is so saddenning.
I have had many many diagnoses including BPII by one supposed expert in the field, and an odd diagnosis by a maverick psychiatrist who believes that my response to ssri's is indicative of some kind of neurological/seizure disorder. This latter doctor is unconvinced of any bipolar stuff probably because my sleep in consistent (all the time).
I feel I'm out of answers, and the motivation to keep going on.
Does anything I said above make anyone think of anything? I'll try anything and entertain any hypothesis at this point.
Scott
Posted by bob on December 16, 2001, at 22:50:38
In reply to It's been awhile...need some help, posted by Mr. Scott on December 16, 2001, at 21:56:06
Scott:
What you have written sounds like exactly what I might say. You've described me perfectly. I also have anxiety problems on top of everything (both mental, as well as mucscle tension). Your statement about watching the world go by sums it up. I think about that everyday. I also get agitation, or restlessness from the ADs. The higher the dose, the more dulled I feel. I too feel like I'm truly out of answers. About the only meds I haven't tried are MAOIs... and I have a REALLY hard time believing they're going to be the one single med that will change my life for good. The one longshot hope for me is that possibly VNS may show some promise. I think these drugs are a serious bust for a lot of us.
Bob
Posted by ChrisK on December 17, 2001, at 4:11:27
In reply to It's been awhile...need some help, posted by Mr. Scott on December 16, 2001, at 21:56:06
Hi Scott,
This is only from my experience but if you see some hope from an AD that may boost your depression baseline I would stick with it and look for some type of augmentation that may clear up your remaining symptoms.
For the apathy/lethargy I found help with Mirapex. It also helped lift my anhedonia problems. It is definitely not a stand alone AD but it has helped to get me off my ass and doing things in the real world again.
I don't have the agitation problems so much but I think that is in part because I have been on Zyprexa for a long time.
A lot of people here seem to find Lamictal to be a good augmentation strategy. I've never tried it but looking at some of the posts on this board it is on my short list of things to try should I run into some form of poopout.
My main suggestion though, would be to look into Mirapex to get rid of some of that apathy.
Best wishes,
Chris
Posted by Mitch on December 17, 2001, at 10:29:21
In reply to It's been awhile...need some help, posted by Mr. Scott on December 16, 2001, at 21:56:06
>
> Hello friends and fellow sufferers,
>
> I am chronically depressed (the lethargic, rejection sensitive type), easily overstressed, and always anxious and obsessing. Every time I take an (ssri/Effexor)antidepressant I notice an immediate improvement in the rejection sensitvity, and the feeling of total helplessness, as well as the obsessing. At the same time I tend to get angry more easily, I feel agitated, I act "goofy" or giddy and immature even. Something definately happens along the lines or irritability and agitation that isn't right. At the same time that I feel physically & mentally agitated, my brain is eaasily dulled by ssri's (not so much Effexor)My face also swells which really bothers me.
>
> My quality of life is truly depleted and it seems I can do nothing about it. I am watching the world and my life go by, and it is so saddenning.
>
> I have had many many diagnoses including BPII by one supposed expert in the field, and an odd diagnosis by a maverick psychiatrist who believes that my response to ssri's is indicative of some kind of neurological/seizure disorder. This latter doctor is unconvinced of any bipolar stuff probably because my sleep in consistent (all the time).
>
> I feel I'm out of answers, and the motivation to keep going on.
>
> Does anything I said above make anyone think of anything? I'll try anything and entertain any hypothesis at this point.
>
> Scott
Scott,I experience the EXACT same response to SSri's (can't seem to live without them-can't shoot 'em). If I go without taking any of them my cycling settles down, but I become humorless, asocial, and start having OCD/GAD-like ruminations and situational panicky feelings. The doc that thinks it may be something to do with a seizure disorder may really be onto something. I have to push the dose of SSRI down,down,down... otherwise I get a lot of temporal lobe symptoms such as grouchiness, spaciness, music playing in my head all the time, etc. BUT, if I stop the SSRI I feel like crap. So, I take Neurontin and a tiny amount of Celexa (2mg/day). The Celexa, even at that small of a dose creates a "night and day" difference. I also can relate to the "goofy" and "giddy" reactions that you mention. They feel like mini-hypomanias that only last a few hours at most. Something else I noticed-if someone tells a joke and I laugh loudly and suddently (while taking SSri), I get intensely dizzy and nearly pass out. I noticed it the most on Luvox. With Luvox I would also turn intensely red in the face and my face muscles would clench and I would feel panicky-then it would fade. With Celexa it was just intense brief dizziness (maybe 3-5 seconds)with spots in front of my eyes (like white-noise on a TV), and I am OK. With Zoloft I noticed it a lot less. Thanks for asking about that-it may be a more common experience than we think.
Anybody else have these sort of reactions to SSRI's??Mitch
Posted by Bob on December 17, 2001, at 15:46:48
In reply to Re: It's been awhile...need some help » Mr. Scott, posted by Mitch on December 17, 2001, at 10:29:21
Yes: SSRIs are a nasty double-edged sword for me also. They seem to induce cycling, fatigue, apathy, agitation, along with other problems. Every once in awhile, I get a little "awakening" of a few hours or so. I absolutely cannot live unmedicated, however. They do reduce ruminations, anger, etc.
Posted by Mr. Scott on December 17, 2001, at 18:23:06
In reply to Re: It's been awhile...need some help, posted by bob on December 16, 2001, at 22:50:38
Bob:
It is good to hear I am not alone, but at the same time knowing what I know I'm sorry to hear you too have this same set of symptoms. What do you take for it? And what is your diagnosis?
I find incomplete but at least some minor positive effect from benzos, but these too have there obvious drawbacks so I minimize their usage. I can tolerate 37.5 mg of effexor and that plus the low dose benzo pretty much is what I currently work with.
Scott
Posted by Mr. Scott on December 17, 2001, at 18:41:45
In reply to Re: It's been awhile...need some help » Mr. Scott, posted by Mitch on December 17, 2001, at 10:29:21
Mitch:
What is your Diagnosis? What is your favorite medication or combo of them?
I kind of like mild valium like benzos (as opposed to Klonopin), but the relief is limitted at best and the side effect profile although mild is still annoying (increased appetite, attention & memory issues).
I just wish our doctors were discussing this like we are.
Scott
Posted by Mr. Scott on December 17, 2001, at 18:42:44
In reply to Re: It's been awhile...need some help, posted by Bob on December 17, 2001, at 15:46:48
Are you a clear cut bipolar?
Posted by Mr. Scott on December 17, 2001, at 18:44:41
In reply to Re: It's been awhile...need some help, posted by ChrisK on December 17, 2001, at 4:11:27
Chris:
Mirapex has been added to the list. I don't know a great deal about it except it is used for Parkinson's mainly.
Scott
Posted by bob on December 17, 2001, at 22:49:42
In reply to Re: It's been awhile...need some help » bob, posted by Mr. Scott on December 17, 2001, at 18:23:06
> Bob:
>
> It is good to hear I am not alone, but at the same time knowing what I know I'm sorry to hear you too have this same set of symptoms. What do you take for it? And what is your diagnosis?
>
> I find incomplete but at least some minor positive effect from benzos, but these too have there obvious drawbacks so I minimize their usage. I can tolerate 37.5 mg of effexor and that plus the low dose benzo pretty much is what I currently work with.
>
> Scott--------------------------------------------------
Scott:I think there are plenty of people who have the problem we have, but I'm not so sure the medical community, or the sufferers see it like we've described. I have a feeling it would more likely be portrayed as intolerance to the meds. I believe my diagnosis is unipolar depression. The problem is that's in the absence of meds. I also now have significant comorbid anxiety. It seems very easy for me to get pushed into irritability, anger, or agitation on any type of energizing med. This leaves me stuck mostly with the sedating meds, which just kills energy and motivation.
I am now taking 50mg Luvox along with .5mg Clonazepam daily. It isn't working all that well. I am depressed in the mornings, and spend all day working out of it. I need something more.
Posted by Mitch on December 18, 2001, at 0:09:19
In reply to Re: It's been awhile...need some help » Mitch, posted by Mr. Scott on December 17, 2001, at 18:41:45
> Mitch:
>
> What is your Diagnosis? What is your favorite medication or combo of them?BPII, ADHD, Social Phobia/panic
Neurontin is my favorite mood stabilizer (best AD, attention-improving and anxiolytic response to),
Klonopin the most effective benzo (for panic/SP),
however I found that chlordiazpoxide or clorazepate worked better for GAD symptoms and caused less depressive/cognitive problems.
Celexa the most effective SSRi (for SP),
Wellbutrin most effective AD for depression (Adderall is even more effective without provoking cycling-but it makes me too edgy and panicky).>
> I kind of like mild valium like benzos (as opposed to Klonopin), but the relief is limitted at best and the side effect profile although mild is still annoying (increased appetite, attention & memory issues).Yes, I agree there.
>
> I just wish our doctors were discussing this like we are.
>
> Scott
They probably are *reading* this! They probably discuss all of this stuff when they hang out professionally, but they all are different when it comes to experimentation that could backfire.Mitch
Posted by Anna Laura on December 18, 2001, at 0:13:51
In reply to It's been awhile...need some help, posted by Mr. Scott on December 16, 2001, at 21:56:06
Hi Mr. Scott
I really don't know what to say except i have similar reaction to SSRI (apathy, lack of motivation). The situation improved with effexor and reboxetine combo which got me rid of the pessimistic negative thinking pattern and lack of motivation; i'm still anhedonic though and i don't get any pleasure whatsoever.
This is kind of weird since i apparently look more lively and i make a lot of projects, have a great deal of new ideas since i'm much less dulled, i take care of myself more often etc... but it's just pure DRIVE wihout pleasure, feeling like a soldier on duty: i just keep on going, that's all. I do get angry more easily but it's o.K. for me since it works like a fuel to do things : i used to feel discouraged and defeated before that., sitting around and doing nothing except being sorry for myself. I think the best thing you can do is to keep on trying until you find the med you feel more comfortable with: not the miracle drug, just the med that is good enough for you to get you going/started. You might think about improving your quality of life then, which is an important thing to do because when you're depressed you neglect a great deal of life features like social life, job opportunities and interesting and stimulating things that could help you a lot if only you felt good enough to reach out for them. Sometimes depression draw you away from the outside world and gets you isolated: i call it depression induced depression, which is a burden that might significantly diminish your chance to recover and that you should get rid of as soon as you get better enough. You might want to do some psychoterapy too at that point, which it could help, as well as augmenting drug therapy on the top of it. Well, this is just a suggestion, what helped me wouldn't necessarily help you since we're different persons, but it could be an option you might think of. I just wanted to put down all i have learned during my eleven years depression. Just a thought....
Take care and don't ever loose hope.
P.S.
FOR BOB: WHAT IS VNS ?
Posted by bob on December 18, 2001, at 12:42:13
In reply to Re: It's been awhile...need some help, posted by Anna Laura on December 18, 2001, at 0:13:51
Here's one of many articles on the web:
http://www.pslgroup.com/dg/15131a.htm
Posted by bob on December 18, 2001, at 13:02:35
In reply to Re: It's been awhile...need some help » Mr. Scott, posted by Mitch on December 18, 2001, at 0:09:19
I highly doubt many doctors are looking at this board. Any time I've ever mentioned opinions, ideas, facts, or suggestions gleaned from this board, I hear about how only people with "problems" (i.e. the complainers) post to boards like these and that you should be careful about any info posted here. I agree that you can't believe everything you read... but at the same time, I think they're discounting the vast experience base represented here -- as well as the fact that many of these posters are extremely knowledgeable about pyschopharmacology. They claim that if you get a good response to a medecine, you wouldn't be on this board. Where does that leave the non-responders???
Posted by Mr. Scott on December 18, 2001, at 19:26:36
In reply to Re: It's been awhile...need some help » Mitch, posted by bob on December 18, 2001, at 13:02:35
My last pill doc was anti Internet in general and very anti this board saying it was a representation of the worst possible cases.
Needless to say he's been replaced
Posted by bob on December 18, 2001, at 21:40:21
In reply to Re: It's been awhile...need some help » bob, posted by Mr. Scott on December 18, 2001, at 19:26:36
Mr. Scott:
Once again, I would venture to say that most of todays experienced doctors probably wouldn't be taking to the internet too much. On the whole they'd be in their 40's, or even older, and as a result would hardly even have been exposed to computers, let alone the internet.
I think it really comes down to their collective view (or possibly what has been told to them in school) about the value of what can come out of one mood disorder sufferer talking to another. From everything I've seen, not much credence is placed in a patient walking in and suggesting things based on what he's heard from another individual (non professional). The internet adds more lack of credibility since it's somewhat anonymous.
Posted by bob on December 18, 2001, at 21:43:25
In reply to Re: It's been awhile...need some help » bob, posted by Mr. Scott on December 18, 2001, at 19:26:36
> My last pill doc was anti Internet in general and very anti this board saying it was a representation of the worst possible cases.
>
> Needless to say he's been replaced-------------------------------------------------
I guess your last pill doc only wanted the easy cases, huh?
Posted by Mitch on December 18, 2001, at 23:29:01
In reply to Re: It's been awhile...need some help » Mitch, posted by bob on December 18, 2001, at 13:02:35
> I highly doubt many doctors are looking at this board. Any time I've ever mentioned opinions, ideas, facts, or suggestions gleaned from this board, I hear about how only people with "problems" (i.e. the complainers) post to boards like these and that you should be careful about any info posted here. I agree that you can't believe everything you read... but at the same time, I think they're discounting the vast experience base represented here -- as well as the fact that many of these posters are extremely knowledgeable about pyschopharmacology. They claim that if you get a good response to a medecine, you wouldn't be on this board. Where does that leave the non-responders???
I must admit that you are correct about your assumptions and I have been too optimistic. I have aggressively switched docs in recent years and not allowed myself to get stuck with docs that are just marking x's on their calendar until they retire. Most folks are uneasy about "shopping around" for a pdoc.
There also is an interesting contrast of "non-responders" (treatment-resistant folks), and treatment-intolerant folks. The treatment-resistant people probably will get more attention (just by the nature of the problem-and justifiably so), while treatment-intolerant folks will get the worst "discounting" that you mention ("It is all in your head-these side effects are just b.s.").
My current pdoc agrees with me that you can't just go on statistical/clinical generalizations when it comes to dx and treatment options. If you are "falling outside the middle of the bell curve" you need individualized treatment (which is what you are supposed to get anyway!). It takes a truly insightful pdoc to treat you uniquely and not get too hung-up with getting the dx "right" and using the treatment which works for most with the most general symptoms.
Mitch
Posted by Noa on December 19, 2001, at 18:52:39
In reply to Re: It's been awhile...need some help, posted by bob on December 16, 2001, at 22:50:38
> and I have a REALLY hard time believing they're going to be the one single med that will change my life for good.That may be true--a lot of us need combos of several meds.
Posted by Noa on December 19, 2001, at 18:53:41
In reply to Re: It's been awhile...need some help, posted by bob on December 16, 2001, at 22:50:38
.....and a combo of therapy and meds.
This is the end of the thread.
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