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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Enigma on January 10, 2005, at 19:47:07
I've had a worsening depression over the years that no medication or other treatment has helped.
I was bipolar, but my hypo-manic days haven't been seen for at least year or more.
My specific problems (at their worst) are:
1) No desire to get out of bed, to be with friends, go out of the house, etc
3) I can't seem to find enjoyment in anything, and hence don't want to do anything - so I'm useless at work, at home, etc. I can't even clean my office (where I spent most of my time).
4) Suicidal thoughts - won't do it, but I think about it, a lot, just as an escape from being depressed all the time
5) Irritibilty with certain people, and mainly when driving
6) Holding down my job had been near impossible - I'm on disability at the momentI've tried many drugs of the years, mostly 2-3 in combination. Wellbutrin, Depakote, Cymbalta, Symbyax, Trileptal, Paxil, Zoloft, Lamictal Effexor, Cyprexa, Lexapro, Prozac, Risperdal, Zyprexa, and about 3 others or more. I have NOT tried any MAOI's, yet.
Risperdal at 1mg (I think) has been 50% effective for my depression, by itself. Mixing it with other meds didn't seem to have any effect, besides having more side effects.
I have gained weight with Risperdal, which, well, on a thin guy like me, sucks big time. Risperdal has also had the opposite effect as prozac when it comes to sex. Instead of taking a very long time to orgasm (or not at all), now it's well, the opposite, and just doesn't feel "right".
Anyway, my short term disability is near complete, and I have to go back to work. Either that or go on long term which only pays 66% of my salary, and I'll face the good chance my job won't be there when I come back.
It is time for MAOI's? These scare the hell outta me. Since my memory is crap, I'd probably forget which things don't mix with MAOI's and take them by accident.
Therapy is useless for me (tried it many times) as I'm "chemically" depressed. I'm just depressed, not about anything in particular. I have nothing I feel I need to talk about, or anything besides my depression that upsets me (well there's other drivers..).
I'm not confident that other other ssri's or other meds are going to have any effect on the depression. Only Risperdal, and possibly Prozac has had any effect. Many, like Effexor and Lexapro had *severe* side effects, especially when trying to taper off them
My doctor doesn't want me to go back on prozac because it was one med in a cocktail that got me a short stay at the hosipital for severe suicidal thoughts.
I'm not sure what else to do.
I'm dreading going back to work, and if I'm going to be able to function there at all (or even get up to and get INTO work for starters).
Please help!
Posted by jerrympls on January 10, 2005, at 19:54:04
In reply to Severe depression - nothing I've tried has worked, posted by Enigma on January 10, 2005, at 19:47:07
If you haven't tried an MAOI - it could be just the thing. The diet restrictions are not as bad as they've been made out to be and I think you can find a lot fo NEW information on this board regarding that. Also, as far as accidentally taking an OTC med w/ an MAOI - I did and survived - but it's best to go through your medicine cabinet and throw out anything that's contraindicated so you don't have it around and don't accidentally take it.
MAOI's are not scarey - really - and they can help someone in your position. Hopefully others on this board will post their positive experiences with Nardil, Parnate, etc.
Hang in there...
Jerry
Posted by lunesta on January 10, 2005, at 20:00:22
In reply to Severe depression - nothing I've tried has worked, posted by Enigma on January 10, 2005, at 19:47:07
Try high dose Neurontin, or much more preferably Lyrica at higher doses as well.
Also try Keppra, and have you considered opiates?
If your pdoc is conservative, start with Ultram or Neurontin (or both at the same time!)
lunesta
Posted by ed_uk on January 10, 2005, at 20:02:17
In reply to Severe depression - nothing I've tried has worked, posted by Enigma on January 10, 2005, at 19:47:07
Hello,
Which tricyclic antidepressants have you tried?
Ed.
Posted by lunesta on January 10, 2005, at 20:05:29
In reply to Re: Severe depression - nothing I've tried has worked » Enigma, posted by jerrympls on January 10, 2005, at 19:54:04
jerry,
not to scare anyone from testing a potential treatment, but i followed to a tee everything for using Nardil for social phobia mostly, and had my first and only grand-mal tonic-clonic seizure and I now have severe minor disabilities since then (from dropping onto a metal shelf at Target, and then to the ground, and then of oxygen deprivation).
I would suggest MAO's last option, I think Enigma has many more options as long as a doctor is willing. Higher dosed Lyrica or Provigil are good choices.
lunesta
Posted by jerrympls on January 10, 2005, at 20:13:10
In reply to Re: Severe depression - nothing I've tried has worked » jerrympls, posted by lunesta on January 10, 2005, at 20:05:29
> jerry,
>
> not to scare anyone from testing a potential treatment, but i followed to a tee everything for using Nardil for social phobia mostly, and had my first and only grand-mal tonic-clonic seizure and I now have severe minor disabilities since then (from dropping onto a metal shelf at Target, and then to the ground, and then of oxygen deprivation).
>
> I would suggest MAO's last option, I think Enigma has many more options as long as a doctor is willing. Higher dosed Lyrica or Provigil are good choices.
>
> lunestaI agree- MAOI's aren't without some serious precautions - but they can help when all else has failed. Sorry to hear about your experience while on Nardil.
Jerry :-)
Posted by banga on January 10, 2005, at 20:18:38
In reply to Re: Severe depression - nothing I've tried has worked » jerrympls, posted by lunesta on January 10, 2005, at 20:05:29
Have you tried other atypical antipsychotics? There are quite a few that don't cause weight gain. If Rispredal helped some, maybe another would too (or even be better??) At least for short term my depression and anxiety was helped by Geodon; there is also Seroquel and Abilify. If you look at remedyfind.com, people hav elisted Seroquel as 2nd best in helping bipolar. Word is--Seroquel better for anxiety symptoms, but can make you drowst. Abilify is more activating but can worsen anxiety.
I also was helped more by TCAs than SSRIs.
Posted by ace on January 10, 2005, at 22:12:28
In reply to Severe depression - nothing I've tried has worked, posted by Enigma on January 10, 2005, at 19:47:07
I didn't read the entire post, I;'m sorry...
But I would recommend Risperidone + MAOI.
Nardil is the best MAOI- brilliant in fact! Parnate also produces great results
good luck friend
ace
Posted by Optimist on January 10, 2005, at 22:55:11
In reply to Severe depression - nothing I've tried has worked, posted by Enigma on January 10, 2005, at 19:47:07
You're bipolar and you haven't tried lithium yet? Is there a specific reason for it?
Lithium + Parnate(MAOi) tends to be very effective for many bipolars. It may just be the thing that gets you out of your rut.
You could always add an anticonvulsant to the mix as well.
Lithium + Lamictal + Parnate is also very effective.
ECT is another good option for severe bipolar/depression.
Posted by ixus on January 11, 2005, at 12:21:33
In reply to Severe depression - nothing I've tried has worked, posted by Enigma on January 10, 2005, at 19:47:07
Yes, It's time for MAOI. Parnate (tranylcypromine) will be a valid option. Plus Klonopin if necessary (0,5-1mg).
For me nothing had work but Parnate. I have not tried Nardil, however, it probably won't have an energy boost effect as Parnate has. Don't be scared, titrate Parnate slowly (from 10mg daily) and observe your BP. Go to 40mg, give it 1 month.
/ixus> I've had a worsening depression over the years that no medication or other treatment has helped.
>
> I was bipolar, but my hypo-manic days haven't been seen for at least year or more.
>
> My specific problems (at their worst) are:
> 1) No desire to get out of bed, to be with friends, go out of the house, etc
> 3) I can't seem to find enjoyment in anything, and hence don't want to do anything - so I'm useless at work, at home, etc. I can't even clean my office (where I spent most of my time).
> 4) Suicidal thoughts - won't do it, but I think about it, a lot, just as an escape from being depressed all the time
> 5) Irritibilty with certain people, and mainly when driving
> 6) Holding down my job had been near impossible - I'm on disability at the moment
>
> I've tried many drugs of the years, mostly 2-3 in combination. Wellbutrin, Depakote, Cymbalta, Symbyax, Trileptal, Paxil, Zoloft, Lamictal Effexor, Cyprexa, Lexapro, Prozac, Risperdal, Zyprexa, and about 3 others or more. I have NOT tried any MAOI's, yet.
>
> Risperdal at 1mg (I think) has been 50% effective for my depression, by itself. Mixing it with other meds didn't seem to have any effect, besides having more side effects.
>
> I have gained weight with Risperdal, which, well, on a thin guy like me, sucks big time. Risperdal has also had the opposite effect as prozac when it comes to sex. Instead of taking a very long time to orgasm (or not at all), now it's well, the opposite, and just doesn't feel "right".
>
> Anyway, my short term disability is near complete, and I have to go back to work. Either that or go on long term which only pays 66% of my salary, and I'll face the good chance my job won't be there when I come back.
>
> It is time for MAOI's? These scare the hell outta me. Since my memory is crap, I'd probably forget which things don't mix with MAOI's and take them by accident.
>
> Therapy is useless for me (tried it many times) as I'm "chemically" depressed. I'm just depressed, not about anything in particular. I have nothing I feel I need to talk about, or anything besides my depression that upsets me (well there's other drivers..).
>
> I'm not confident that other other ssri's or other meds are going to have any effect on the depression. Only Risperdal, and possibly Prozac has had any effect. Many, like Effexor and Lexapro had *severe* side effects, especially when trying to taper off them
>
> My doctor doesn't want me to go back on prozac because it was one med in a cocktail that got me a short stay at the hosipital for severe suicidal thoughts.
>
> I'm not sure what else to do.
>
> I'm dreading going back to work, and if I'm going to be able to function there at all (or even get up to and get INTO work for starters).
>
> Please help!
Posted by johnsmith12345 on January 12, 2005, at 3:48:25
In reply to Re: Severe depression - nothing I've tried has worked, posted by ixus on January 11, 2005, at 12:21:33
Try the MAOIs, either Nardil or Parnate. They are known to have better success rates than the other things you have tried. I am beginning them tomorrow after four years of failed medicines. Even if they don't work, I very much regret not trying them earlier just because of some dietary restrictions and the irrational fear that most doctors have of precribing them. I honestly wish my doctor had put me on them immediately after the first SSRI had failed. Give me side effects, risk of a heart attack, whatever. Just don't let my depression continue for years and years on end because prescribing an MAOI would make you feel uncomfortable.
Also, there are some good tips here:
http://www.acnp.org/g4/GN401000105/Default.htm
Posted by Ktemene on January 12, 2005, at 9:03:16
In reply to Re: Severe depression - nothing I've tried has worked » jerrympls, posted by lunesta on January 10, 2005, at 20:05:29
It does sound as if it is time for you to try a MAOI. Lunesta was quite right to point out that they can be dangerous, and everyone who takes them should be careful and aware of the dangers. But, MAOI's have been around for fifty years, and the dangers are well known, and you can estimate the dangers with a fair degree of confidence. There seems to be a consensus among pdocs that MAOI's are the most effective medications for atypical depression, that is to say, most effective for the kind of depression you have. Lots of people on Babble have had great success with MAOI's after every other medication had failed them. Try reading an old post from a man whose history with depression is very similar to yours: "All that's old is new again" http://www.dr-bob.org/babble/19990914/msgs/12171.html
Posted by Ed O`Flaherty on January 13, 2005, at 3:37:49
In reply to Re: Severe depression - nothing I've tried has wor, posted by Ktemene on January 12, 2005, at 9:03:16
Nutritional treatment might help.One of the best places to go to is Pfeiffer Center near Chicago where around 2 out of 3 bipolar patients will get a useful benefit.They do various tests on one`s chemistry and recommend nutrients such as zinc,amino acids and a whole lot more.See details on www.hriptc.org . I do some of this type of work on a small scale in Ireland and it can indeed be very effective in many cases as an addition to but not as a replacement for standard psychiatric treatment of schizophrenia,bipolar disorder and depression.It is by far the most useful and satisfying work I do as a physician.I have some details on www.omega3.20megsfree.com
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