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Dr. Bob is Robert Hsiung, MD,
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Posted by wcfrench on October 16, 2002, at 16:41:43
Wonderful people
I saw this on a TV show, and I'm not sure if it's been posted here before, but I wanted to make sure everyone here knows about it. There's a study going on around the U.S. for treatment-resistant depression. You can visit the website and take the preliminary screening to see if you qualify. I'll save you some time and post the crux of it here. It says that it involves taking a combination of two "novel" medicines, or just one of the two, decided by chance. And by novel, probably meaning that the medicines are unique from other antidepressants. I hope some people can benefit from this since I am sure a lot of us are in this boat.
The URL is www.trialfordepression.com
Here is the info
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Treatment-Resistant Depression (TRD) OverviewThe information in this section is provided by Veritas Medicine.
Despite significant advances in the treatment of depression, currently available antidepressant medications do not work for everyone. As many as 30% to 40% of patients with major depressive disorder do not respond to a course of treatment with antidepressants. And a significant number of patients do not respond to multiple treatment courses. These individuals have a condition now recognized as treatment-resistant depression (TRD). TRD is known as depression that persists or shows only slight improvement after standard treatment with antidepressant medications.
Because there are many causes for the symptoms of depression, and because depression covers a range of symptoms associated with complex biological changes in the brain, there can be many reasons why standard treatments fail to relieve depressive symptoms.
Evaluation and Diagnosis
The diagnosis of TRD is made when symptoms of depression persist or show only slight improvement, despite appropriate treatment with medications. Before a diagnosis of TRD can be made, it is necessary to carefully examine a patient's medical history (including an assessment of their adherence to the prescribed medication regimen) and to complete laboratory tests that can help identify potential causes of depression.NOTE: The failure to treat depression properly is not the same as treatment-resistant depression.
Causes of TRD
Depression is associated with a variety of changes in the structure and function of the brain. Treatment-resistant depression has been specifically related to changes in the front portion of the cortex of the brain and a deep structure connected to this region known as the striatum. Psychological and social factors such as prior treatment failures, stress, or coping styles may also be important in TRD. TRD does not necessarily indicate the presence of additional psychiatric illness such as a personality disorder, but may be associated with stable and sustained depressive traits.Treatment Strategies for TRD
When a patient appears to have TRD, it is first necessary to verify that the failed treatments have been given properly and that the patient has adhered to the treatment regimen. Detectable medical causes of depression, such as reduced thyroid function, should also be identified. Medication-based treatment strategies for TRD can take one of a variety of approaches, such as:Switching Therapies (discontinuing one antidepressant and starting another) — Some individuals will have noticeably different responses to medications even when the newer medication is in same class of antidepressants (such as the SSRI class). The important point here is that different medications, no matter how similar their primary function, may have subtle differences that impact the treatment of the individual patient. When switching medications, however, many physicians prefer to change to a different class of antidepressant.
Combination therapy (adding one or more additional antidepressant medications to those already in use) — The existing evidence suggests that broadening the antidepressant treatment regimen to include two drugs that work differently than each other is more likely to be successful than using either drug alone. In this strategy, a new medication will be added to existing treatment; the patient does not have to withdraw from the original medication during the add-on process. However, the effectiveness of this strategy requires further scientific study.
Augmentation (adding other medications that are not antidepressants themselves, but that boost or augment the antidepressant already in use) — Many augmentation strategies exist for boosting the effects of an antidepressant medication. The addition of thyroid hormone and lithium are common strategies. Other augmenting agents, such as beta-blockers (used for migraine and heart conditions) and a variety of vitamin, hormone, and herbal strategies, require additional study. Recent evidence suggests that blocking cortisol (a stress-related hormone) can treat psychotic depression, but the role of cortisol-blocking medications in TRD remains to be determined.
Additionally, non-medication-based therapies can also be used to treat TRD. They include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TCMS), and vagus nerve stimulation (VNS). ECT is a well-established treatment for TRD, whereas TCMS and VNS are potential therapies requiring more study.
Summary
Treatment-resistant depression is diagnosed when an individual fails to respond to a standard antidepressant treatment. Individuals with TRD can suffer sustained impairment in their quality of life. Further research is needed to better understand this condition. Future treatment of TRD may involve the use of novel medications.
Posted by wcfrench on October 18, 2002, at 2:05:47
In reply to Medicine for treatment-resistant depression, posted by wcfrench on October 16, 2002, at 16:41:43
I think I do. I have been on Effexor, Seroquel, Zyprexa, Geodon, Neurontin, Paxil, and Klonopin.. not all at the same time of course. Then we tried Lithium with Remeron which didn't work, and now Lithium and Zoloft, and at first I felt a response, but now I feel nothing. It initally seemed to have an effect but it has subsided, and this is the same thing that has happened in the past. Has anyone else ever had this? A response initially, but almost like a quick poop-out, then nothing...? Just hoping there are others that have experienced this, and I am hoping to learn from you and share this info with you. Thanks for any response.
Posted by glenn on October 18, 2002, at 5:23:32
In reply to DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by wcfrench on October 18, 2002, at 2:05:47
Hi,
Well yes I guess I would have that, although one shrink dismissed me as a neurotic depressive, whatever that is and my current doc who is marvellous says im like an oil tanker that needs to be turned around!- hes probably right.
Frustrating isnt it taking all these meds and suffering horrible side effects and very little gain.
I had the experience you mention with amisulpride,
worked for about a week then no more- very disappointing.
I think for many of us on here the current favourite drugs such as ssris are not really hitting the bullseye, you might find the post I am going to do tomorrow (hopefully)interesting
it is about new meds and supplements/ herbs that I have only recently found out about.
Good luck if you go on the trial.Glenn
Posted by Lyn on October 19, 2002, at 4:41:38
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by glenn on October 18, 2002, at 5:23:32
I was first diagnosed with depression eight years ago after the birth of my second child (he is eight years old tomorrow!), but have actually suffered most of my life. I have tried screeds of medication, ECT and therapy, all to no avail. All the doctors have now given up on me and suggested I read self-help books and not bother them any more. They also gave me the label which I understand they give to all 'difficult' patients: personality disorder.
Posted by rod on October 19, 2002, at 13:16:59
In reply to DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by wcfrench on October 18, 2002, at 2:05:47
I dont know if it is TRD or just inproper treatment at all. Once a doctor diagnosed TRD.
I have tried Prozac, Reboxetine, Amitryptiline, Celexa, Zyprexa + Prozac (TRD combo), Mianserin, Cloimipramine, Effexor. Some alone or in combination.
Currently my medication (Amitryptiline + Effexor + Vit B + Omega3 + L-Thyrosine) is working quite well for me, and I hope I will not relapse, like I did many times before...wish you the best
rod> I think I do. I have been on Effexor, Seroquel, Zyprexa, Geodon, Neurontin, Paxil, and Klonopin.. not all at the same time of course. Then we tried Lithium with Remeron which didn't work, and now Lithium and Zoloft, and at first I felt a response, but now I feel nothing. It initally seemed to have an effect but it has subsided, and this is the same thing that has happened in the past. Has anyone else ever had this? A response initially, but almost like a quick poop-out, then nothing...? Just hoping there are others that have experienced this, and I am hoping to learn from you and share this info with you. Thanks for any response.
Posted by wcfrench on October 19, 2002, at 14:14:54
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by rod on October 19, 2002, at 13:16:59
Rod
Interesting to see you are doing well on such a combination of medicine, and encouraging too. I wonder, how did you come about this cocktail.. did your doctor recommend those supplements (I don't know much about L-Thyrosine) or did you come to that conclusion on your own? When did it seem to be apparent that they were helping your depression, and what worked the "best" if any one could be picked? I just moved to a new area and my doctor had no referral to give me, so I'm looking for a new one. Hopefully we can further delve into the issue by exploring other treatment options, and not just give the infamous "TRD" or "personality disorder" diagnosis. Thanks for your help.
-Charlie
Posted by rod on October 19, 2002, at 14:36:53
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION???? » rod, posted by wcfrench on October 19, 2002, at 14:14:54
> Rod
>
> Interesting to see you are doing well on such a combination of medicine, and encouraging too. I wonder, how did you come about this cocktail.. did your doctor recommend those supplements (I don't know much about L-Thyrosine) or did you come to that conclusion on your own?All of them on my own, inspired by some good ideas on this board. Just tried them without the knowledge of my doctor, but then told her afterwards.
I do not even know one doctor who recommended such thing to a patient (I visit a local support group for over one year and know a lot about the treatment of other patients). Some of them say that its just the placebo effect I feel. Hmm, but I dont think so (why didnt I do good on my prior medication if it only is the placebo effect?).
> When did it seem to be apparent that they were helping your depression, and what worked the "best" if any one could be picked?Im general right from the first few days.
The "best" is Omega-3 for me. Brilliant for sleep and "the awful feeling of depression in my brain, like a stange headache". (maybe this sounds weired, but I experience it that way)> I just moved to a new area and my doctor had no referral to give me, so I'm looking for a new one. Hopefully we can further delve into the issue by exploring other treatment options, and not just give the infamous "TRD" or "personality disorder" diagnosis. Thanks for your help.
>
> -Charlie
wish you the best
rod
Posted by wcfrench on October 19, 2002, at 14:47:42
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by rod on October 19, 2002, at 14:36:53
I know what you mean about the placebo effect. My last doctor told me the same stuff, and refused to believe that you could feel the effects of an antidepressant during the first week. I wanted to be like, "then you take it and see!" And exactly, why does it only work on some medicines?
Thanks for the info on the omega-3, I'm going to try to get some today. Does it make you fall asleep, as in should only be taken at night time? How about the other stuff, beneficial, expensive/cheap?
Thanks again.
Take care,
Charlie
Posted by rod on October 19, 2002, at 14:52:14
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by wcfrench on October 19, 2002, at 14:47:42
>Does it make you fall asleep, as in should only be taken at night time?
makes me tired, disstressed, ready for bed.
>How about the other stuff, beneficial,
expensive/cheap?expensive, sadly.
>
> Thanks again.
> Take care,
> Charlie
Posted by Ed O`Flaherty on October 19, 2002, at 17:03:00
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by rod on October 19, 2002, at 14:52:14
> >Does it make you fall asleep, as in should only be taken at night time?
>
> makes me tired, disstressed, ready for bed.
>
>
> >How about the other stuff, beneficial,
> expensive/cheap?
>
> expensive, sadly.
>
> >
> > Thanks again.
> > Take care,
> > Charlie
>
>
There is about a one in three chance that omega-3 fish oil will work here.The dose varies from person to person but typically about 1- 3g of
omega-3 (total of EPA and DHA) would be a reasonable dose for depression according to the latest articles in the literature.Some depresssed patients actually do better on a small dose of 1g and you might try that for a few weeks initially.Side effects should not be a problem and if they are consider Eskimo 3 capsules.
Posted by ayrity on October 19, 2002, at 23:47:06
In reply to DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by wcfrench on October 18, 2002, at 2:05:47
Yup, me too.
I've been on various combinations of Celexa, Effexor,Wellbutrin, Provigil and Parnate. Just stopped the Parnate about a week ago and might start Nardil soon; had to stop the Parnate because of blood pressure problems.
Supposedly, MAOIs often work well when other classes have failed. I think this is my last shot at meds, then I'm through with them, all I get is bad side effects and no benefit. Actually, I think I have treatment-resistant life! Been like this as long as I can remember. Maybe it's just me; maybe it's just that life sucks for some people and there's nothing you can do about it, not meds, psychotherapy, nothing. Well, at least nothing I've tried yet seems to help.
Posted by ayrity on October 19, 2002, at 23:48:37
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by ayrity on October 19, 2002, at 23:47:06
Forgot, tried Moclobemide, too. Add that to the list. No bad side effects, but no benefit either.
Posted by Lyn on October 20, 2002, at 2:45:25
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by ayrity on October 19, 2002, at 23:48:37
Is anyone considering following up on the study? Are such things common in the US?
Posted by wcfrench on October 20, 2002, at 3:04:49
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by Lyn on October 20, 2002, at 2:45:25
I've thought about it, but I need to give my current medication some time before I decide. Another 5-6 weeks.
I did check it out, and "qualified." They ask you about any health conditions, and what meds you have tried, and if you have a thyroid disorder. The only thing is, it may require up to 21 visits over the course of 6 weeks, so it's a little less than once a week. (at worst) But the nearest center to where I live is about an hour and a half, so I'll need to give it a little time before I agree to the program. Sounds interesting though, and hopeful. If things continue to go unimproved, I'm going to give it a shot.
Posted by Lyn on October 20, 2002, at 3:34:50
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by wcfrench on October 20, 2002, at 3:04:49
> I've thought about it, but I need to give my current medication some time before I decide. Another 5-6 weeks.
>
> I did check it out, and "qualified." They ask you about any health conditions, and what meds you have tried, and if you have a thyroid disorder. The only thing is, it may require up to 21 visits over the course of 6 weeks, so it's a little less than once a week. (at worst) But the nearest center to where I live is about an hour and a half, so I'll need to give it a little time before I agree to the program. Sounds interesting though, and hopeful. If things continue to go unimproved, I'm going to give it a shot.It sounds very positive, doesn't it? I hope your current meds help. If not, then perhaps this programme will. Good luck.
Over the course of 8 years or so I've tried all sorts or meds (Prozac, Aropax, Nortriptilene, Moclobemide, Serzone, Doxepin, Serzone (again), Olanzapine, Aropax (again), Risperadol and Seroquel, plus others I can't even name; but to no avail. Recently I had a possible lifeline suggested to me, and am currently waiting to hear if I have been accepted for a treatment programme at a private clinic. It really is my last hope; the doctors I have seen this year won't even bother trying to prescribe anything any more, they say it is a waste of time. I hope the funding for this clinic comes through. I can't carry on like this any longer.
Posted by polarbear206 on October 21, 2002, at 19:33:36
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION????, posted by Lyn on October 20, 2002, at 3:34:50
> > I've thought about it, but I need to give my current medication some time before I decide. Another 5-6 weeks.
> >
> > I did check it out, and "qualified." They ask you about any health conditions, and what meds you have tried, and if you have a thyroid disorder. The only thing is, it may require up to 21 visits over the course of 6 weeks, so it's a little less than once a week. (at worst) But the nearest center to where I live is about an hour and a half, so I'll need to give it a little time before I agree to the program. Sounds interesting though, and hopeful. If things continue to go unimproved, I'm going to give it a shot.
>
> It sounds very positive, doesn't it? I hope your current meds help. If not, then perhaps this programme will. Good luck.
>
> Over the course of 8 years or so I've tried all sorts or meds (Prozac, Aropax, Nortriptilene, Moclobemide, Serzone, Doxepin, Serzone (again), Olanzapine, Aropax (again), Risperadol and Seroquel, plus others I can't even name; but to no avail. Recently I had a possible lifeline suggested to me, and am currently waiting to hear if I have been accepted for a treatment programme at a private clinic. It really is my last hope; the doctors I have seen this year won't even bother trying to prescribe anything any more, they say it is a waste of time. I hope the funding for this clinic comes through. I can't carry on like this any longer.
>Lyn,
Have you tried Lamictal, Lithium, Depakote, or Trileptal in combination with an antidepressant? What about the MAOI's? Did you try an SSRI/tricyclic combo?
Posted by Lyn on October 22, 2002, at 4:25:20
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION LYN, posted by polarbear206 on October 21, 2002, at 19:33:36
>
>
> Lyn,
>
> Have you tried Lamictal, Lithium, Depakote, or Trileptal in combination with an antidepressant? What about the MAOI's? Did you try an SSRI/tricyclic combo?
>
I've tried the combination of Aropax (SSRI - I think it is Paxil in the US) and Nortriptilene (tricyclic); this had absolutely no effect. Maclobemide brought about nothing but a skin rash. Nardil gave me a dreadful headache so I had to stop it at about three weeks - too early to gauge a response. I've never been prescribed Lithium. I'd not heard of Lamictal, Trileptal or Depakote before, but a search shows me that lamictal and Trileptal should at least be available here. Are they used as mood stabilisers?
Posted by wcfrench on October 22, 2002, at 4:56:43
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION LYN, posted by Lyn on October 22, 2002, at 4:25:20
Lamictal is a mood stabilizer. BarbaraCat is on it and having some relief from depression, you might want to check out her writings in the thread called Remeron - adios, Lamictal hello. It's above this post.
I have been on Neurontin, another mood stabilizer, with little relief. But BCat says there's a doctor who has shown Lamictal to help unipolar depression as well. I am interested in that, and will give you some more information if/when I find it.
Take care,
Charlie
Posted by Lyn on October 22, 2002, at 15:23:09
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION LYN, posted by wcfrench on October 22, 2002, at 4:56:43
> Lamictal is a mood stabilizer. BarbaraCat is on it and having some relief from depression, you might want to check out her writings in the thread called Remeron - adios, Lamictal hello. It's above this post.
>Thanks, I've checked this out.
I go from a catatonic-type depression to a state of extreme anxiety or even severe agitation. In the past the doctors have told me that I am 'stable' and 'doing well' when I am in the anxiety/agitation mode. Personally, I prefer the former; feeling nothing at all seems preferable to feeling like I am going crazy. Was it BarbaraCat that related the experience with the Lobster pot? I gave up eating flesh many year ago because I couldn't stand the thought of another living creature having to die for my benefit - I can't kill icky bugs in the garden or even use fly spray. I remain dry-eyed at funerals, unless I see someone else crying; then I feel so bad for them that I have to cry too. It took several years for anyone to diagnose the anxiety and social phobia, longer for an OCD or agoraphobia diagnosis and, just two years ago (when I had already been in the system for 6 years), Post Traumatic Stress Disorder. I have been labelled a 'difficult' patient and told I have a 'personality disorder'. I don't think they have the diagnosis right yet; I simply don't fit in any of their neat little boxes.
The problem now will be to find a doctor who will actually prescribe anything. I'm hoping to hear about the clinic within the next two weeks; it really is my only hope.
> I have been on Neurontin, another mood stabilizer, with little relief. But BCat says there's a doctor who has shown Lamictal to help unipolar depression as well. I am interested in that, and will give you some more information if/when I find it.
>
> Take care,
> CharlieDo you think you will be able to switch medications? There doesn't seem to be any point to staying on something that doesn't help. I look forward to hearing more about Lamictal.
Thanks, Charlie, and good luck with your search for the right medication.
Posted by wcfrench on October 22, 2002, at 20:13:14
In reply to Re: DO YOU HAVE TREATMENT-RESISTANT DEPRESSION LYN, posted by Lyn on October 22, 2002, at 15:23:09
Good luck with the study Lyn, I hope it works out. It seems that as our situation becomes more sticky we need to look outside the box a bit more. Supplements, forums, recommendations. I'd love to see if Lamictal could possibly help me. I read a bit from Dr. Ivan Goldberg claiming that it has been shown to relieve unipolar depression. There are several Q&As I will quote, but only the most relevant ones:
4. How does lamotrigine differ from other mood stabilizing drugs?
Lamotrigine differs from other mood stabilizing drugs in two major ways:
1. Lamotrigine's frequent effectiveness for patients who have failed to respond to antidepressants or mood stabilizers;
2. Lamotrigine's relatively benign side-effect profile.
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5. What, if anything, uniquely distinguishes lamotrigine from carbamazepine and valproate?Lamotrigine has had been successful in controlling rapid cycling and mixed bipolar states in people who have not received adequate relief from lithium. carbamazepine and/or valproate. It also appears that lamotrigine has significantly more antidepressant potency than either carbamazepine or valproate.
Lamotrigine has recently been reported to be a useful treatrment for some people with post-traumatic stress disorder (PTSD) and/or borderline personality disorder (BPD).
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6. People with what sorts of psychisatric disorders are candidates for treatment with lamotrigine?It is too early to be very specific about which mood disorders are most likely to respond to treatment with lamotrigine. There are few published reports on lamotrigine's use in psychiatry. Patients with hard-to-treat bipolar syndromes and with schizoaffective disorder have been treated more often than patients with "treatment-resistant" unipolar disorders. Some people with such hard to treat unipolar depressions have been treated with good results. Some patients diagnosed with Borderline Personality Disorder, a disorder that many psychiatrists believe is a varient of Bipolar Disorder, have responded to treatment with lamotrigine. Patients with Post-Traumatic Stress Disorder and with Deopersonalization Disorder have also rersponded well to lamotrigine therapy.
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7. Is lamotrigine useful for the treatment of acute depressed, manic and mixed states, and can it also be used to prevent future episodes of mania and/or depression?The initial use of lamotrigine was to treat people with depressed, manic and mixed states that did not respond to existing medications. Some patients are now being maintained on lamotrigine on a long term basis in an attempt to prevent future episodes. The effectiveness of lamotrigine as a long-term prophylactic agent is currently being established.
Hope this helps! See you guys later.
-Charlie
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