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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by greywolf on April 28, 2004, at 9:40:22
In an earlier post I inquired about whether a therapeutic benefit could ever reasonably be expected from Wellbutrin when one hasn't been experienced at 300mg/day. I'm now at 400mg/day, so we'll soon find out.
I'm very concerned at this point that I will find nothing effective to help me with BPII and OCD. The depressive component is severe, and becoming moreso with each episode. About 5 years ago, I was involved in regular therapy and a meds regimen designed to address a BP problem that was getting out of control and led to self-injury (fortunately nothing major). It basically centered on lithium and a revolving door of SARI and SSRIs, as well as the old Wellbutrin. Nothing worked even remotely well enough to justify the SEs, and the only recourse suggested by my doctors at that point was shock treatment, so I just gave up on all of it (including therapy), and made some major life changes that I thought would be positive, but in the long run resulted in replacing one bad situation with a string of others.
After a couple years of handling things on my own (generally badly), I decided to try the pharmaceutical approach again last year. Since then, Lexapro, Effexor, Trazodone, and Wellbutrin have been ineffective. The Wb is the best of the lot because it has only very minimal SEs, but it too has not accomplished anything therapeutic.
My doctor is very reluctant to try any MAOIs because of realistic concerns that the dietary restrictions just won't work with my lifestyle, and he's pushing this Wb trial like it's my best hope.
So, I am hoping that you kind advisors in Babble land might give me some advice on what to do when all of these meds prove ineffective. Right now we are really focused on getting the depression under control because the hypomania is manageable as long as I stay away from alcohol and opportunities to take risks during those periods. Also, I am extremely reluctant to go back on the lithium for reasons that are probably not quite logical, but relate to the fact that so many bad things happened while I was on it. The anxiety flowing from being unable on a long-term basis to mitigate this depression appears to have manifested itself in more obvious physical symptoms of OCD that I was better able to control in the past, so relief for one may be relief for the other as well. And yes, I've tried CBT with little success.
Somebody throw me a line :)
Posted by Sad Panda on April 28, 2004, at 13:44:03
In reply to What to do if you don't respond to SSRI/NDRI/SARI?, posted by greywolf on April 28, 2004, at 9:40:22
> In an earlier post I inquired about whether a therapeutic benefit could ever reasonably be expected from Wellbutrin when one hasn't been experienced at 300mg/day. I'm now at 400mg/day, so we'll soon find out.
>
> I'm very concerned at this point that I will find nothing effective to help me with BPII and OCD. The depressive component is severe, and becoming moreso with each episode. About 5 years ago, I was involved in regular therapy and a meds regimen designed to address a BP problem that was getting out of control and led to self-injury (fortunately nothing major). It basically centered on lithium and a revolving door of SARI and SSRIs, as well as the old Wellbutrin. Nothing worked even remotely well enough to justify the SEs, and the only recourse suggested by my doctors at that point was shock treatment, so I just gave up on all of it (including therapy), and made some major life changes that I thought would be positive, but in the long run resulted in replacing one bad situation with a string of others.
>
> After a couple years of handling things on my own (generally badly), I decided to try the pharmaceutical approach again last year. Since then, Lexapro, Effexor, Trazodone, and Wellbutrin have been ineffective. The Wb is the best of the lot because it has only very minimal SEs, but it too has not accomplished anything therapeutic.
>
> My doctor is very reluctant to try any MAOIs because of realistic concerns that the dietary restrictions just won't work with my lifestyle, and he's pushing this Wb trial like it's my best hope.
>
> So, I am hoping that you kind advisors in Babble land might give me some advice on what to do when all of these meds prove ineffective. Right now we are really focused on getting the depression under control because the hypomania is manageable as long as I stay away from alcohol and opportunities to take risks during those periods. Also, I am extremely reluctant to go back on the lithium for reasons that are probably not quite logical, but relate to the fact that so many bad things happened while I was on it. The anxiety flowing from being unable on a long-term basis to mitigate this depression appears to have manifested itself in more obvious physical symptoms of OCD that I was better able to control in the past, so relief for one may be relief for the other as well. And yes, I've tried CBT with little success.
>
> Somebody throw me a line :)
>
>Hi Greywolf,
Out of the four AD's you mention, Wellbutrin & Trazdone tend to be very weak as AD's & are mostly used as add on drugs to help with drugs that are working. Wellbutrin is generally used as an energy booster & Trazodone for sleep. The best drugs for OCD are SRI type drugs of which Lexapro & Effexor are. I would suggest at least trying Zoloft & if that fails, try Clomipramine.
Did Lexapro or Effexor help you at all? What side effects did you have?
Cheers,
Panda.
Posted by greywolf on April 28, 2004, at 19:03:12
In reply to Re: What to do if you don't respond to SSRI/NDRI/SARI? » greywolf, posted by Sad Panda on April 28, 2004, at 13:44:03
Sad Panda:
Thanks for your thoughts. I have tried both Zoloft (about 3 months) and Effexor (a little over a month), but stopped because the sedation SE was so strong. I write all day (and many nights), so that SE is particularly bothersome. Both meds also had significant sexual SEs.
I was on a course of either clomipramine or imipramin about 4 years ago. I believe it was clomipramine directed in part at OCD symptoms. It also had serious sedating effect, and after 4-5 months I had to stop because the SE had not dissipated and even a relatively high dosage (I can't recall exactly, but it was close to max dose) did not produce a significant therapeutic benefit. I also took 3 months off from work around that time and weaned myself off of everything to try an exercise and diet approach to my problems. I ended up with a nice tan, a better jump shot, and caught up on my reading, but apparently exercised my demons instead of exorcizing them. Long story short, it ended up being just a break from treatment instead of a realistic approach to these illnesses.
My experience suggests that I am resistant to treatment with SARI, SSRI, NDRI, SNRI, trycyclics, you name it. Trazodone did have some effect, but it was so damn sedating that even taking it only at night wiped me out the next day. My doctor is not a fan of stimulants, so the only thing he has been willing to suggest along those lines is Wellbutrin. Unfortunately, Wb seems to be the weakest of the bunch (at least of those I've tried over the last year). I seriously have not observed any effect of the Wb other than some initial anxiety that disappeared after a few days. Since then, I've felt exactly zero in the way of any effects, positive or negative. I might as well be popping Tic Tacs.
I think a good sign of things to come was the recommendation that the only really effective course of treatment for me would be ECT. That is simply a road I don't want to go down. So now I would like to know whether there are pharmaceutical options other than MAOIs that I have not yet tried, particularly for the depression. I can shut myself in on the manic days and try to channel the euphoria into some productive writing, and I can handle people looking at me oddly when the OCD habits and tics become too obvious, but the depths of these 2-3 week depressive episodes are reaching lows that resemble some very bad times I've had in the past. I handle these circumstances better now after years of treatment, and having people like you on Babble is immensely helpful (particularly in keeping perspective), but the misery is still consuming.
I think I'm wasting my time with the Wb, but I'll do it for a little while longer simply because my doctor has asked me to give it the ol' college try. I just fear that the longer I spend on an ineffective med, the worse the depression gets. The floor for me is making it to work everyday and meeting the majority of my obligations. If I cannot find something that actually works, there's nothing between me and rock bottom if I start missing work. That's what I want to avoid.
Posted by Ilene on April 28, 2004, at 20:50:06
In reply to What to do if you don't respond to SSRI/NDRI/SARI?, posted by greywolf on April 28, 2004, at 9:40:22
I think your pdoc is not well informed. Several people on PB do well on MAOIs.
I'm taking one and I haven't had any dietary problems. Most of the information regarding the dietary restrictions is actually *mis*information. 80% of the reactions are caused by aged cheese. You can eat pizza from Domino's, Pizza Hut, and most of the chains, because the substance they use isn't really cheese.
The only side effect I've had is dizziness from low blood pressure.
On the other hand, I could be popping Tic Tacs...
I.
Posted by Sad Panda on April 29, 2004, at 5:05:53
In reply to Re: What to do if you don't respond to SSRI/NDRI/S, posted by Ilene on April 28, 2004, at 20:50:06
>the substance they use isn't really cheese.
>LOL! It is cheese Jim, but not as we know it. :)
MAOI's are very under utilized. The potential for a fatal reaction is very real, but overhyped.
Posted by Sad Panda on April 29, 2004, at 5:18:15
In reply to Re: What to do if you don't respond to SSRI/NDRI/SARI? » Sad Panda, posted by greywolf on April 28, 2004, at 19:03:12
> Sad Panda:
>
> Thanks for your thoughts. I have tried both Zoloft (about 3 months) and Effexor (a little over a month), but stopped because the sedation SE was so strong. I write all day (and many nights), so that SE is particularly bothersome. Both meds also had significant sexual SEs.
>
> I was on a course of either clomipramine or imipramin about 4 years ago. I believe it was clomipramine directed in part at OCD symptoms. It also had serious sedating effect, and after 4-5 months I had to stop because the SE had not dissipated and even a relatively high dosage (I can't recall exactly, but it was close to max dose) did not produce a significant therapeutic benefit. I also took 3 months off from work around that time and weaned myself off of everything to try an exercise and diet approach to my problems. I ended up with a nice tan, a better jump shot, and caught up on my reading, but apparently exercised my demons instead of exorcizing them. Long story short, it ended up being just a break from treatment instead of a realistic approach to these illnesses.
>
> My experience suggests that I am resistant to treatment with SARI, SSRI, NDRI, SNRI, trycyclics, you name it. Trazodone did have some effect, but it was so damn sedating that even taking it only at night wiped me out the next day. My doctor is not a fan of stimulants, so the only thing he has been willing to suggest along those lines is Wellbutrin. Unfortunately, Wb seems to be the weakest of the bunch (at least of those I've tried over the last year). I seriously have not observed any effect of the Wb other than some initial anxiety that disappeared after a few days. Since then, I've felt exactly zero in the way of any effects, positive or negative. I might as well be popping Tic Tacs.
>
> I think a good sign of things to come was the recommendation that the only really effective course of treatment for me would be ECT. That is simply a road I don't want to go down. So now I would like to know whether there are pharmaceutical options other than MAOIs that I have not yet tried, particularly for the depression. I can shut myself in on the manic days and try to channel the euphoria into some productive writing, and I can handle people looking at me oddly when the OCD habits and tics become too obvious, but the depths of these 2-3 week depressive episodes are reaching lows that resemble some very bad times I've had in the past. I handle these circumstances better now after years of treatment, and having people like you on Babble is immensely helpful (particularly in keeping perspective), but the misery is still consuming.
>
> I think I'm wasting my time with the Wb, but I'll do it for a little while longer simply because my doctor has asked me to give it the ol' college try. I just fear that the longer I spend on an ineffective med, the worse the depression gets. The floor for me is making it to work everyday and meeting the majority of my obligations. If I cannot find something that actually works, there's nothing between me and rock bottom if I start missing work. That's what I want to avoid.
>
>
>Desipramine is the last TCA for you to try, then it's time for an MAOI. If my current meds fail me I will be pushing for a trial of Parnate. I can't see any reason not to try MAOI's except phobia.
You mention euphoria & mania? When do you get them? Have you tried any of the AED/Mood stabilisers?
Cheers,
Panda.
Posted by bipolarspectrum on April 29, 2004, at 9:26:38
In reply to What to do if you don't respond to SSRI/NDRI/SARI?, posted by greywolf on April 28, 2004, at 9:40:22
Hi,
I didnt read the other messages, but someone may have said this before... But i believe, categorically, that you should try an MAOI.. the diet restrictions are not as strict as is often assumed... I am cared for by a leading psychopharm and he continiously tells me that MAOIs are underused and underutilized..
Posted by greywolf on April 29, 2004, at 10:50:19
In reply to Re: What to do if you don't respond to SSRI/NDRI/S, posted by Ilene on April 28, 2004, at 20:50:06
I thought I had responded to this earlier, but no post shows up. I wanted to express my appreciation for your responses and to note that I actually have a pretty well-informed doctor who takes the time to discuss these matters thoroughly. I think his reluctance on the MAOI side is related in part to a self-injury situation I had a few years ago, and in part to the fact that he is aware that my adherence to dietary restrictions for a cholesterol problem wasn't exactly stellar.I don't think he will refuse to try MAOIs if necessary, but at this point he's obviously trying to find something that's in both our comfort zones given my history. I may be more anxious to get on with it, but I trust this doctor and would prefer, personally, to avoid MAOIs until other resources have been exhausted.
Unfortunately, it's pretty clear that I'm coming to that point. So risk concerns related to the MAOIs will probably have to be reassessed soon.
Thanks again for taking the time.
Posted by ravenstorm on April 29, 2004, at 13:26:50
In reply to Re: What to do if you don't respond to SSRI/NDRI/S » Ilene, posted by greywolf on April 29, 2004, at 10:50:19
Maybe the selegiline ensam patch will somehow be out by the end of the year. I have heard because it is a patch, you may not have to follow the dietary restrictions.
I know that that is little comfort right now.
Its interesting about the food thing, because I read over the restrictions and I can't really eat anything on the list anyway due to stomach/allergy problems (no dairy, no chocolate, no alcohol etc etc) the only thing I would miss would be the soy sauce/chinese food thing.
Hang in there. I know its terrible trying to find a med. I went through horrible and protracted paxil withdrawal that left me worse off than before and seemingly unable to tolerate ssri's anymore.
I have been trying to find a new med since last November and am currently on week three of 15mg remeron. I must say, it has the easiest start up affects and I am seeing improvement but it is too soon to say whether this is the right med for me.
Good luck!
P.S. Some people have had really good luck combining remeron and another ssri or effexor. Have you ever tried a combo?
Posted by Ilene on April 29, 2004, at 15:55:04
In reply to Re: What to do if you don't respond to SSRI/NDRI/S » Ilene, posted by greywolf on April 29, 2004, at 10:50:19
>
> I thought I had responded to this earlier, but no post shows up. I wanted to express my appreciation for your responses and to note that I actually have a pretty well-informed doctor who takes the time to discuss these matters thoroughly. I think his reluctance on the MAOI side is related in part to a self-injury situation I had a few years ago, and in part to the fact that he is aware that my adherence to dietary restrictions for a cholesterol problem wasn't exactly stellar.
>Knowing that you could die alters your perception of the food restrictions. Also, the headache you get from a hypertensive crisis has been described as "the mother of all headaches". I've tested my reaction to soy (Kikkoman), but not to cheese, and I carry an antidote wherever I go.
> I don't think he will refuse to try MAOIs if necessary, but at this point he's obviously trying to find something that's in both our comfort zones given my history. I may be more anxious to get on with it, but I trust this doctor and would prefer, personally, to avoid MAOIs until other resources have been exhausted.
>
> Unfortunately, it's pretty clear that I'm coming to that point. So risk concerns related to the MAOIs will probably have to be reassessed soon.
>I got to that point, and I'm back again. I've been feeling a little better but I don't think it's due to the MAOI, so I'm back to "what do I do now"?
> Thanks again for taking the time.
Posted by sexylexy on April 30, 2004, at 16:11:50
In reply to Re: What to do if you don't respond to SSRI/NDRI/S » greywolf, posted by Ilene on April 29, 2004, at 15:55:04
Ladies Help!
I am on 20mg of Lexapro and feel pretty darn good until that lovely time of the month comes into play. 10 days before my period I can actually physically feel the medication stop working. I know that all of my "lexapro e-friends" feel the same way. Are any of you on a SSRI that helps to curve PMDD or PMS. I swear, I am giving up too much time to these stupid hormones!!! I would GREATLY appreciate your help!
Lexy
This is the end of the thread.
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