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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Racer on May 1, 2004, at 12:02:46
Thanks for reading this, I'm so anxious and worried about going back on anti-depressants, and want to figure out what I can and can't tolerate, and what drugs might be worth trying -- probably trying again, but that's why I'm so anxious...
Here's the quick and dirty:
I suffer major, unipolar depression. My blood pressure runs rather low, and a lot of ADs seem to lower it still further, which I really can't tolerate -- not that I mind it, just that falling down isn't therapeutic ;-) The biggest problems I've had on ADs have been weight gain, which is a real issue for me, since I already feel big as a house, and it seems that everyone around me obsesses over my weight as much as I do. Weight gain is and has been a major issue for me most of my life, and my already impaired body image really magnifies that.
Any thoughts? So far, the drugs that have been most effective have worked on norepinephrine systems, as well as seratonin.
Thanks for reading.
Posted by SLS on May 1, 2004, at 13:04:07
In reply to Chemist, wanna muse on suggestions?, posted by Racer on May 1, 2004, at 12:02:46
Hi Racer.
What are you experiencing that indicates to you the emergence of depression?
Which drugs have helped?
Which drugs have hurt?
Have you ever been symptom-free?
- Scott
Posted by Racer on May 1, 2004, at 15:04:37
In reply to Re: Chemist, wanna muse on suggestions?, posted by SLS on May 1, 2004, at 13:04:07
>
> What are you experiencing that indicates to you the emergence of depression?
>
Trust me, this isn't the emergence of depression, it's full blown depression with a side order of anxiety bordering on terror. This episode has been going on for about a year now, and treatment for it started last July, with relatively little relief from any of the drugs so far -- except for Wellbutrin, which is contraindicated for me, because of a history of head trauma and a possible eating disorder.> Which drugs have helped?
>
Let's see, I had some relief from Nortriptyline 20 years ago, but it caused weight gain of over 70 pounds and insomnia.Then, 12 years ago, Paxil helped, but at the cost of major sedation -- I didn't feel fully awake for the two years I was on it -- plus constipation, emotional deadening, weight gain of 50+ pounds, and sexual disfunction.
A combination of Effexor XR and Prozac helped, but there was a LOT of breakthrough depression. On average, during the 4 years I was on it, I probably spent one day per month unable to get out of bed during the first two or three years, with the last year being much worse: full blown depression for a pretty significant portion of the entire year. That was along with weight gain of somewhere between 40 - 55 pounds (I stopped getting on the scale), sexual disfuntion, that "brain zap" sensation, heavy sweating, and a few other less bothersome problems. Oh, yeah, and it took 8 months to wean off of it, during which time I had that Effexor withdrawal hell going on.
Provigil, as an augmenting agent, did seem to help, but it was too stimulating. I felt as if I were speeding all the time -- and other people noticed and commented on it, as well. (I was taking 50mg per day, along with a few other drugs.)
So, partial response to a few drugs, and it's hard to remember any of them being worth the adverse reactions -- although I know that that's the depression distorting my perceptions, it's still hard to consider trying again.
> Which drugs have hurt?
>
Desiprimine provided me some sudden, close up views of the carpeting. Lexapro was so deadening I stopped it because I just couldn't tolerate it. Serzone was a nightmare: within a few weeks, I was in the hospital with something that may or may not have been mono, but for months after that -- until I finally stopped taking it -- I couldn't walk across the room without holding on to something, and had problems with insomnia, anxiety, suicidal ideation (maybe because I felt so wretched?), nausea and vomiting, etc. Zoloft caused so much physical tension and muscle jerking I couldn't sleep, as well as doing nothing I could see for the depression.> Have you ever been symptom-free?
>
That is a very hard question to answer. I don't know right now, because the depression is making it seem as if life has always been this bad, and nothing has ever helped. I don't know if that means that I'm too depressed to remember having felt better, or if it's a fairly accurate assessment of reality.>
> - ScottThank you for your warm and generous response to my question.
Posted by chemist on May 1, 2004, at 15:56:36
In reply to Re: Chemist, wanna muse on suggestions?, posted by Racer on May 1, 2004, at 15:04:37
>
hi racer, i am sorry to hear about the depths of your despair....Scott's posts are, in my opinion, quite excellent, and his knowledge in particular about the meds you have taken and are considering is superior to mine: i defer to Scott. for the record, i would have suggested effexor, given that i have known some *personal* success stories and given that it is a second-generation SSRI...but again, i defer to Scott, Panda, and King Vultan on this one...apologies for not being more of a help, but i feel that these other posters are more educated and experienced with the efficacy of these drugs than i.....all the best, chemist
> >
> > What are you experiencing that indicates to you the emergence of depression?
> >
> Trust me, this isn't the emergence of depression, it's full blown depression with a side order of anxiety bordering on terror. This episode has been going on for about a year now, and treatment for it started last July, with relatively little relief from any of the drugs so far -- except for Wellbutrin, which is contraindicated for me, because of a history of head trauma and a possible eating disorder.
>
> > Which drugs have helped?
> >
> Let's see, I had some relief from Nortriptyline 20 years ago, but it caused weight gain of over 70 pounds and insomnia.
>
> Then, 12 years ago, Paxil helped, but at the cost of major sedation -- I didn't feel fully awake for the two years I was on it -- plus constipation, emotional deadening, weight gain of 50+ pounds, and sexual disfunction.
>
> A combination of Effexor XR and Prozac helped, but there was a LOT of breakthrough depression. On average, during the 4 years I was on it, I probably spent one day per month unable to get out of bed during the first two or three years, with the last year being much worse: full blown depression for a pretty significant portion of the entire year. That was along with weight gain of somewhere between 40 - 55 pounds (I stopped getting on the scale), sexual disfuntion, that "brain zap" sensation, heavy sweating, and a few other less bothersome problems. Oh, yeah, and it took 8 months to wean off of it, during which time I had that Effexor withdrawal hell going on.
>
> Provigil, as an augmenting agent, did seem to help, but it was too stimulating. I felt as if I were speeding all the time -- and other people noticed and commented on it, as well. (I was taking 50mg per day, along with a few other drugs.)
>
> So, partial response to a few drugs, and it's hard to remember any of them being worth the adverse reactions -- although I know that that's the depression distorting my perceptions, it's still hard to consider trying again.
>
> > Which drugs have hurt?
> >
> Desiprimine provided me some sudden, close up views of the carpeting. Lexapro was so deadening I stopped it because I just couldn't tolerate it. Serzone was a nightmare: within a few weeks, I was in the hospital with something that may or may not have been mono, but for months after that -- until I finally stopped taking it -- I couldn't walk across the room without holding on to something, and had problems with insomnia, anxiety, suicidal ideation (maybe because I felt so wretched?), nausea and vomiting, etc. Zoloft caused so much physical tension and muscle jerking I couldn't sleep, as well as doing nothing I could see for the depression.
>
> > Have you ever been symptom-free?
> >
> That is a very hard question to answer. I don't know right now, because the depression is making it seem as if life has always been this bad, and nothing has ever helped. I don't know if that means that I'm too depressed to remember having felt better, or if it's a fairly accurate assessment of reality.
>
> >
> > - Scott
>
> Thank you for your warm and generous response to my question.
>
Posted by SLS on May 1, 2004, at 16:23:38
In reply to Re: Chemist, wanna muse on suggestions?, posted by Racer on May 1, 2004, at 15:04:37
Gosh. You've got quite a challenging case there. I guess that's almost a comical understatement, yes?
The first thing that occurs to me is that the anxiety should be the first symptom to target. If you have not found an antidepressant that can mitigate your anxiety, then I think you might want to consider one of the atypical antpsychotics or a benzodiazepine like Klonopin. I think Seroquel might be the first drug to try. Anxiety is often the trigger for suicidality. I know these are serious drugs, but you are in a very serious situation. I would have recommended Zyprexa first, but I doubt you would have been amenable to using it due to the almost certain weight gain that would result. Weight gain is possible from Seroquel too, but it is much reduced compared to Zyprexa.
> and treatment for it started last July, with relatively little relief from any of the drugs so far -- except for Wellbutrin, which is contraindicated for me, because of a history of head trauma and a possible eating disorder.
I feel that the risk of seizure from Wellbutrin is often exaggerated. You might want to investigate its use in your case more thoroughly before abandoning it as an option. I can't imagine you not considering Parnate. Have you ever tried it? I know of people who are responsive to both of these drugs who are resistant to most others. There might be a tendency towards cross-responsivity; if you respond to Wellbutrin, you might have a better than average chance to respond to Parnate as well.
It sounds as if you will probably need to combine an antidepressant(s) with an anxiolytic or possibly a mood stabilizer. If you throw enough crap against the wall, some of it is bound to stick. I try to keep telling myself this.
Parnate?
Remeron?
Thyroid?
Depakote?
Lamictal?
Adderall?
- Scott
Posted by Racer on May 1, 2004, at 17:43:43
In reply to Re: Chemist, wanna muse on suggestions?, posted by SLS on May 1, 2004, at 16:23:38
What you've said is pretty scary, since none of those sound like anything I'd want to deal with. (MAOIs would not be on my top ten list, because of the dietary restrictions. Honest to God, I'd rather die than give up sour cream, pepperoni pizza, good cheese and a glass of wine. You know?)
Actually, that's probably not a parenthetical topic. Right now, I'm trying to get my mind around the idea that I'll have to take these damned drugs for the rest of my life, rather than taking them for the two to five years post-remission that we've been looking at in the past. The constellation of side effects involved takes on a different picture under those circumstances. The dietary restrictions involved in taking MAOIs are pretty close to out of the question for me, though. Even if I could do it short term -- and I'm not sure I wouldn't be attempting suicide over that alone -- there's just no way I could do it long term.
Your post did clarify some things for me, though -- largely about the anxiety side of it. This is where separating the psychopharmacology from the rest of the psychological issues really worries me. My therapist is probably coming to see that I hide my anxiety pretty well, but it's so strongly ingrained in me that fear must be hidden, lest it make me a target for worse, that I have a real problem admitting to any fears. I think, up until now, my pdoc hasn't managed to learn that about me. Maybe talking to him about that as a starting point would be a good idea?
(Especially since he considers me to be a "melancholic" depressive -- sure, but with a hell of a lot of anxiety. If I look motionless, it's because I'm using all my energy to hide my fear, you know?)
Thanks again, Scott. I appreciate your help.
Posted by SLS on May 1, 2004, at 18:17:53
In reply to Re: SLS, Thank you, posted by Racer on May 1, 2004, at 17:43:43
Hi Racer.
> Your post did clarify some things for me, though -- largely about the anxiety side of it. This is where separating the psychopharmacology from the rest of the psychological issues really worries me. My therapist is probably coming to see that I hide my anxiety pretty well, but it's so strongly ingrained in me that fear must be hidden, lest it make me a target for worse, that I have a real problem admitting to any fears. I think, up until now, my pdoc hasn't managed to learn that about me. Maybe talking to him about that as a starting point would be a good idea?
You might be surprised at how much more manageable things seem once the anxiety is removed or at least mitigated. You may not even know what it's like to be without it. There is always an interplay between the mind and the brain. Even if your anxiety is rooted in the psychological, manipulating the biological temporarily using medication might allow you to more easily process the issues that produced it in the first place. It doesn't sound like your anxiety is 100% psychological, though. What do you think?
- Scott
Posted by gardenergirl on May 1, 2004, at 19:08:02
In reply to Re: SLS, Thank you, posted by SLS on May 1, 2004, at 18:17:53
Racer,
Just thought I would share my experience on Nardil. If you've heard this before from me, I apologize. Can't remember if we talked about this before.Nardil has been the only AD that has been effective for my atypical depression. My main symptoms were excessive sleeping (I think related to just wanted to hide in bed and not do anything), mood reactivity (not always feeling sad and blue...I could laugh at funny stuff, but just didn't last), rejection sensitivity (leads to major avoidance behaviors on my part), and a type of leaden paralysis (I knew I needed to get up and out of bed, but I couldn't make myself move.)
I was worried about the dietary restrictions as well, and in fact rejected my T's suggestion for about 2 months before deciding to try it. I had been on Celexa and Wellbutrin, so I had to taper off of those and wash out before I started on the Nardil. During that wash out period I "practiced" the diet to make sure I could really do it. It wasn't that bad, even when I was following it religiously. Although I still miss certain cheeses, like Irish Cheddar, Havarti, etc.
Here's what I have learned through research both empirical and personal: I can drink red or white wine in moderation (2-3 glasses, which is my limit, anyway 'cuz I'm a lightweight.) I can have mozzarella, provolone, ricotta, and goat cheese (admittedly haven't eaten the goat cheese in quantity, still testing that one.) So pizza is in!!!! Yeah!! I have also read that you can have Brie, if you don't eat the rind. Haven't tried that yet. I can have sour cream and yogurt if they are not too close to the expiration date. I've even had things with the dreaded and ubiquitous "autolyzed yeast extract" in it without a reaction, but I'm careful to note how far down on the ingredients list it comes (the lower it is the greater the likelihood of smaller amount). I can have domestic beer, including Sam Adams, just can't have tap beer (gave me gas, anyway) or microbrews. I plan to try an Amstel Light soon, but I will continue to stay away from my beloved Bass Ale.
The only tyramine reaction I had (and it was never verified that my BP was elevated) was at Thanksgiving. My aunt used the giblets in the dressing. Oops, Mom never did that, so it never occurred to me. After dinner I had a doozy of a headache/migraine for about 2 1/2 hours. It went away on its own.
Eating out at restaraunts can be a challenge. You have to read the menu carefully and ask the server a lot of questions. I printed out business card sized cards with the restrictions on it. This has worked out well. I pick out one or two entrees, hand them the card, and ask the server to check with the cook/chef to see what they recommend given my limitations. I have never had to go hungry at a restaurant, although I have had to pass up things I would have ordered in the past.
Hope this helps. More important, I hope you find what will work for you as much as Nardil has worked for me. I don't even have much in the way of SE's anymore. Joy!
gg
Posted by Racer on May 1, 2004, at 21:57:47
In reply to Re: SLS, Thank you, posted by SLS on May 1, 2004, at 18:17:53
> You might be surprised at how much more manageable things seem once the anxiety is removed or at least mitigated. You may not even know what it's like to be without it.
You know, about now I'd like to be surprised that way. ;-D I'm certainly going to talk to the doctor about that.
> It doesn't sound like your anxiety is 100% psychological, though. What do you think?
>If you've read my most recent posts on the other board, I think you'll see some of the other things going on. I don't know how to separate out what is "just" psychological from what might be something else. As far as I have ever heard, anxiety is always psychological -- so I'd love to hear what you mean by that.
(If you do read about the rest of it, though, you may figure out why I say I'd rather take any further discussion of this to email. If you're willing to do that, you can reach me at babbler39 at excite dot com.)
>
> - Scott
Posted by SLS on May 2, 2004, at 9:50:46
In reply to Re: SLS, Thank you, posted by Racer on May 1, 2004, at 21:57:47
> As far as I have ever heard, anxiety is always psychological
Oh, no, no, no.
Without going into a big spiel about the amygdala (a region of the brain involved in the experience of fear), I think we can look at the more obvious. Do you know of any drug that can produce anxiety? Do you know of any drug that produces anxiety as a symptom of its withdrawal? Yes, of course. Biological manipulation of the function of the brain can produce anxiety in the absence of a change in psychology. So, too, can an idiopathic aberation of brain function or physiological alterations secondary to depressive illness or chronic psychosocial stress. Panic disorder, social anxiety, social phobia, and generalized anxiety disorder might make for good examples of these scenarios. Panic and severe anxiety can come out of nowhere during some types of epileptic seizures (partial seizures lateralized to the right temporal lobe).
- Scott
Posted by Keith Talent on May 3, 2004, at 6:20:20
In reply to Re: SLS, Thank you » Racer, posted by SLS on May 2, 2004, at 9:50:46
Racer, how about:
clomipramine or (Prozac + Strattera) at high doses
clonazepam?
Posted by zeugma on May 3, 2004, at 16:45:14
In reply to Re: SLS, Thank you, posted by Keith Talent on May 3, 2004, at 6:20:20
Racer, i have similar symptoms ("melancholic" depression which makes my pdocs think I can't be anxious, but in fact my amygdala feels like it's being assaulted on a daily basis). I am considering a similar regimen to the one Keith suggested. I think it would have a fair chance of targeting "melancholic" plus anxious symptomology, plus Strattera is something of a mild weight-gain suppressant for most.
This is the end of the thread.
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