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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 109 to 133 of 133. Go back in thread:
Posted by Noa on April 14, 2001, at 12:21:55
In reply to Re: treatment resistant depression-- » Shar, posted by sweetmarie on April 13, 2001, at 11:58:48
Sweetmarie--good luck in hospital.
Posted by sweetmarie on April 14, 2001, at 13:46:47
In reply to Re: treatment resistant depression--, posted by Noa on April 14, 2001, at 12:21:55
> Sweetmarie--good luck in hospital.
Thanks very much (much appreciated),Anna.
Posted by sweetmarie on April 15, 2001, at 11:32:37
In reply to Re: going into hospital » Shar, posted by sweetmarie on April 12, 2001, at 15:13:33
This is it - final posting.
Thank you VERY VERY VERY much to everyone who has responded to me.
So now I`m off to hospital, and
in the words of Morrissey:
`please please please let me get what I want ... this time`
and in the words of Arnie:
`I`ll be back`
and to everyone:
keep on keeping on
Thanks once again - this board has been a tremendous help, and I wish everyone the very best of health.
And thanks to Dr Bob for being a diamond geezer.
Anna.
Posted by Dr. Bob on April 15, 2001, at 14:51:25
In reply to FINALLY GOING » sweetmarie, posted by sweetmarie on April 15, 2001, at 11:32:37
> And thanks to Dr Bob for being a diamond geezer.
Come again? :-)
Bob
PS: Good luck!
Posted by sweetmarie on April 15, 2001, at 15:41:04
In reply to Re: a what? » sweetmarie, posted by Dr. Bob on April 15, 2001, at 14:51:25
> > And thanks to Dr Bob for being a diamond geezer.
It`s a cockney expression for a jolly good chap.
> PS: Good luck!
Thanks,
Anna.
Posted by ShelliR on April 15, 2001, at 18:02:18
In reply to FINALLY GOING » sweetmarie, posted by sweetmarie on April 15, 2001, at 11:32:37
> `please please please let me get what I want ... this time`
Anna, we're all wishing that for you.Looking forward to hearing from you when you return to the world at large.
Shelli
Posted by dove on April 16, 2001, at 11:19:24
In reply to Re: FINALLY GOING » sweetmarie, posted by ShelliR on April 15, 2001, at 18:02:18
Dearest Anna,
My prayers, thoughts, and hopes are with you. Please know that we will all be here when and if you need us. You have given so much to this board, you've shared so much of yourself, your struggles that I just want to say "Thank You" one more time :-)
Please come back and update us all!!! I will be watching for you! My best wishes, my best 'get something good outta this' vibes, and my prayers send I to you! And a BIG hug (((Anna)))
~dove
Posted by sweetmarie on June 17, 2001, at 8:38:02
In reply to Re: FINALLY GOING, posted by dove on April 16, 2001, at 11:19:24
> Dearest Anna,
>
> My prayers, thoughts, and hopes are with you. Please know that we will all be here when and if you need us. You have given so much to this board, you've shared so much of yourself, your struggles that I just want to say "Thank You" one more time :-)
>
> Please come back and update us all!!! I will be watching for you! My best wishes, my best 'get something good outta this' vibes, and my prayers send I to you! And a BIG hug (((Anna)))
>
> ~dove
Dear Dove (and everyone),Well, I`ve been at the hospital (specialist treatment resistant affective disorder unit) for 8 weeks now. It`s a really nice place, and completely unlike any other NHS hospital I`ve ever been in. The best thing is that there are only 10 patients there, and we all get a lot of individual attention from the nurses (who are all - with the exception of one - really nice).
The bad news is that I haven`t experienced a lift in mood (well, maybe a very small one). I`m very frustrated about this obviously, although I`m still told it`s `early days`.
I have a question regarding Venlafaxine/Mirtazapine (Efexor/Remeron - `Zispin` in this country). I have now been on Venlafaxine for 6 weeks, and Mirtazapine for 5 weeks. The Mirtazapine has remained steady at 30 mg, and the Venlafaxine has been gradually increased to 375 mg. I`ve been on this dose for a week now. This could be an impossible question to answer, but here goes -
Does anyone know whether length of time spent on a medication is `counted` from the highest dose, or from when the medication is first taken (at the lowest dose)? I have asked the nurses this question, but frankly they didn`t make all that much sense. I`d be really grateful for any info on this subject ...
Thanks also to Dove for the lovely sentiments - I really appreciate them.
Let me know.
Regards,
Anna.
Posted by Cam W. on June 17, 2001, at 9:10:10
In reply to Re: FINALLY GOING » dove, posted by sweetmarie on June 17, 2001, at 8:38:02
Marie - When mentioned in clinical reviews, the time one should remain taking an antidepressant is 6 months. This means that one should take an antidepressant for "at least" 6 months after remission is attained. It can take 4 to 12 weeks (or longer) to enter antidepressant-induced remission.
OTOH, in clinical trials, the time when starting an antidepressant is used as the starting date. Rarely, are these studies followed through to remission and recovery, but when they are, the studies still use the time when starting the drug, as a start date.
I think this is where the confusion comes in. Really, the date of remission should be judged the start of the antidepressant working, but this date is sort of fuzzy as entering remission is gradual. Therefore, many docs use the rule of thumb that, the first date that they see their patient is recovering (4 - 12 weeks into treatment), they will try to maintain that patient for at least another six months. Most docs nowadays just keep a person on an antidepressant for at least a year from the start date, and then evaluate the person at that time; using their clinical judgement to determine whether that person should remain on an antidepressant or whether it is time to try to take the person off of the antidepressant.
I suppose that it was this sort of wishy-washy answer that the nurses gave you, isn't it? None of these rules are written in stone, and it is really up to the judgement of the doctor. Research has bourne out though, that if people stop taking an antidepressant within 6 months of remission, there is approximately a 60% to 80% chance of relapsing. These figures are for first-time treatment-responsive depressions.
This is probably not the "rule of thumb" in treatment-resistant cases like yours, where long-term therapy, after (if) remission is achieved. So, to answer your question in the context of your treatment-resistant depression: it depends on how you do eventually respond to the medication.
I hope that this mess is of some help. - Cam
Posted by sweetmarie on June 18, 2001, at 5:52:26
In reply to Re: FINALLY GOING » sweetmarie, posted by Cam W. on June 17, 2001, at 9:10:10
> Marie - When mentioned in clinical reviews, the time one should remain taking an antidepressant is 6 months. This means that one should take an antidepressant for "at least" 6 months after remission is attained. It can take 4 to 12 weeks (or longer) to enter antidepressant-induced remission.
>
> OTOH, in clinical trials, the time when starting an antidepressant is used as the starting date. Rarely, are these studies followed through to remission and recovery, but when they are, the studies still use the time when starting the drug, as a start date.
>
> I think this is where the confusion comes in. Really, the date of remission should be judged the start of the antidepressant working, but this date is sort of fuzzy as entering remission is gradual. Therefore, many docs use the rule of thumb that, the first date that they see their patient is recovering (4 - 12 weeks into treatment), they will try to maintain that patient for at least another six months. Most docs nowadays just keep a person on an antidepressant for at least a year from the start date, and then evaluate the person at that time; using their clinical judgement to determine whether that person should remain on an antidepressant or whether it is time to try to take the person off of the antidepressant.
>
> I suppose that it was this sort of wishy-washy answer that the nurses gave you, isn't it? None of these rules are written in stone, and it is really up to the judgement of the doctor. Research has bourne out though, that if people stop taking an antidepressant within 6 months of remission, there is approximately a 60% to 80% chance of relapsing. These figures are for first-time treatment-responsive depressions.
>
> This is probably not the "rule of thumb" in treatment-resistant cases like yours, where long-term therapy, after (if) remission is achieved. So, to answer your question in the context of your treatment-resistant depression: it depends on how you do eventually respond to the medication.
>
> I hope that this mess is of some help. - CamHi Cam,
Thanks for your reply - it WAS of some help.
I think that the idea is that I remain on the successful combination (whether this is the combination I am currently on, or another - if any), long-term. I`ve suffered from moderate - severe depression for most of my life (I`m 34), and the current severe episode has lasted for over 3 years now. I have discontinued meds twice over the past 10 years with disastrous results, so I`m in no hurry to stop taking them any time soon.
The `4 - 12 weeks` you mention is useful; I`ve always been told that the time-span is 3 - 6 weeks. Having said that, I know that the longer the depressive episode has lasted, the longer it takes the meds to have an effect. What I was really after was when the `4 - 12 weeks` (or whatever) is measured from - i.e. is it measured from the onset of taking the med(s), or the beginning of taking the highest dose. In other words, is the period before (hopeful) efficacy measured from the beginning (when a patient begins taking the meds, at a low dose), or from when the meds have been `boosted` to the highest doseage.
Does this make sense? I hope you can get the gist of what I`m asking.
Any `light` on this gratefully appreciated.
Cheers,
Anna.
Posted by Cam W. on June 18, 2001, at 9:50:31
In reply to Re:Treatment Resistant Depression - Efexor/Remeron » Cam W., posted by sweetmarie on June 18, 2001, at 5:52:26
> The `4 - 12 weeks` you mention is useful; I`ve always been told that the time-span is 3 - 6 weeks. Having said that, I know that the longer the depressive episode has lasted, the longer it takes the meds to have an effect. What I was really after was when the `4 - 12 weeks` (or whatever) is measured from - i.e. is it measured from the onset of taking the med(s), or the beginning of taking the highest dose. In other words, is the period before (hopeful) efficacy measured from the beginning (when a patient begins taking the meds, at a low dose), or from when the meds have been `boosted` to the highest doseage.Anna - The answer to your time period question is: both are used, it depends on what the person who s talking. More often than not, clinicians (eg. your doc) mean from the time you start taking the antidepressant. Researchers who talk about staying on medication for 6 months mean, "6 months after remission". This would probably be from the time after the last dosage increase, as remission date is usually a range (ie. no on or off; depressed then not depressed).
Also, you should stay on medication for 4 to 8 weeks after the highest dose is attained to see if the medication will work for you; or 8 to 12 weeks from the start of therapy (which is roughly the same time frame). Again, the time frame that is used is dependent on who you are talking to. This is, of course, if you are able to tolerate the start-up side effects and are still able to function as much as need be.
- Cam
Posted by sweetmarie on June 18, 2001, at 10:45:21
In reply to Re:Treatment Resistant Depression - Efexor/Remeron » sweetmarie, posted by Cam W. on June 18, 2001, at 9:50:31
> Anna - The answer to your time period question is: both are used, it depends on what the person who s talking. More often than not, clinicians (eg. your doc) mean from the time you start taking the antidepressant. Researchers who talk about staying on medication for 6 months mean, "6 months after remission". This would probably be from the time after the last dosage increase, as remission date is usually a range (ie. no on or off; depressed then not depressed).
>
> Also, you should stay on medication for 4 to 8 weeks after the highest dose is attained to see if the medication will work for you; or 8 to 12 weeks from the start of therapy (which is roughly the same time frame). Again, the time frame that is used is dependent on who you are talking to. This is, of course, if you are able to tolerate the start-up side effects and are still able to function as much as need be.
>
Cam,Thanks for that - it`s answered my question.
As I`ve been on Venlafaxine for 6 weeks now (1 week at 375 mg, which I think is as high as they are going to take it), and Mirtazapine for 5 weeks, I imagine that the combination will be guaged from 5 weeks ago (approx). So, I wouldn`t necessarily have noticed any alteration in mood yet.
The `spanner in the works` was that the professor (who is treating me) told me 3 weeks ago that he "expected me to be better in 3 - 4 weeks". Well, the 3 week period elapsd 3 days ago, and frankly I feel virtually no different to when I was first admitted to hospital (i.e. still majorly depressed). It has taken me years to learn NOT to ask the question "when will I be better?", as there is pretty much no meaningful response. So, when the professor volunteered this 3 - 4 week period, I immediately latched onto it, although I knew it to be tenuous. I don`t really know why I`m mentioning this, except to illustrate the nature of my consultant - i.e. very optimistic indeed. No bad thing, but realism is equally as necessary.
Anyway, thanks again. I`m going back to hospital now (I`m currently on home leave), and will `check in` again when I`m next home (next w/end, all being well).
Cheers once again,
Anna.
Posted by Wendy B. on June 20, 2001, at 9:47:05
In reply to Re:Treatment Resistant Depression - Efexor/Remeron, posted by sweetmarie on June 18, 2001, at 10:45:21
(message from Cam)
>
> Thanks for that - it`s answered my question.
>
> As I`ve been on Venlafaxine for 6 weeks now (1 week at 375 mg, which I think is as high as they are going to take it), and Mirtazapine for 5 weeks, I imagine that the combination will be guaged from 5 weeks ago (approx). So, I wouldn`t necessarily have noticed any alteration in mood yet.
>
> The `spanner in the works` was that the professor (who is treating me) told me 3 weeks ago that he "expected me to be better in 3 - 4 weeks". Well, the 3 week period elapsd 3 days ago, and frankly I feel virtually no different to when I was first admitted to hospital (i.e. still majorly depressed). It has taken me years to learn NOT to ask the question "when will I be better?", as there is pretty much no meaningful response. So, when the professor volunteered this 3 - 4 week period, I immediately latched onto it, although I knew it to be tenuous. I don`t really know why I`m mentioning this, except to illustrate the nature of my consultant - i.e. very optimistic indeed. No bad thing, but realism is equally as necessary.
>
> Anyway, thanks again. I`m going back to hospital now (I`m currently on home leave), and will `check in` again when I`m next home (next w/end, all being well).
>
> Cheers once again,
>
> Anna.
Hey Anna,
Hang tight, as they say in the states, meaning - don't give up yet... The 3-4 weeks was probably a bit optimistic, don't you think? It does take an 8-12 week trial to see if the meds will work, for most people. Your professor may have had easier cases prior to you! It's a very tough disease, and I think you're quite right about a dose of reality being necessary, too.I'm glad you're allowed "home leave" (does it feel like you're in the army?). I hope it helps make you feel a little more normalized. I am interested in your responses to being in hospital for such a long time. You seem relatively calm & stable, even when majorly depressed. Do you keep a journal of your experiences? I've heard it helps...
My hat goes off to you and my heart goes out to you. Please do check in when you're home, and we'll be waiting to hear from you with much hope,
Wendy
Posted by sweetmarie on June 22, 2001, at 14:25:15
In reply to Re:Treatment Resistant Depression - Efexor/Remeron » sweetmarie, posted by Wendy B. on June 20, 2001, at 9:47:05
> Hang tight, as they say in the states, meaning - don't give up yet... The 3-4 weeks was probably a bit optimistic, don't you think?That`s what I thought.
It does take an 8-12 week trial to see if the meds will work, for most people. Your professor may have had easier cases prior to you! It's a very tough disease, and I think you're quite right about a dose of reality being necessary, too.
>
> I'm glad you're allowed "home leave" (does it feel like you're in the army?). I hope it helps make you feel a little more normalized.Well ... not really - I spend the time at my parents` place. Pretty stressful (they think that I`m not doing enough for myself etc.).
I am interested in your responses to being in hospital for such a long time. You seem relatively calm & stable, even when majorly depressed.
Hmmm. Not really, but I`m not really able to express distress. To see me, you`d think that nothing was wrong - I`ve got the `I`m perfectly alright` act off to a tee. I`m not sure that this works in my favour.
Do you keep a journal of your experiences? I've heard it helps...
I kind of do - one of my `key` nurses gives me a weeks` schedule, where I complete each period of the day with what I`ve done, and rate my mood out of 10. This is quite useful.
>
> My hat goes off to you and my heart goes out to you. Please do check in when you're home, and we'll be waiting to hear from you with much hope,Thanks - it`s nice to know that others are bothered about me. I think that I`m a little better than I was on admission, i.e. I had my first 7 out of 10 last Saturday night. Still mostly 2s, 3s and 4s though. The Venlafaxine/Mirtazapine combo has now entered week 8, and according to the prof, the next step will be lowering the Venlafaxine dose, and increasing the Mirtazapine dose. We`ll see.
Thankyou ever so much for your interest and support - it`s much appreciated.
Anna.
Posted by sweetmarie on June 24, 2001, at 11:29:45
In reply to Re:Treatment Resistant Depression - Efexor/Remeron » Wendy B., posted by sweetmarie on June 22, 2001, at 14:25:15
I forgot to ask -The next line of attack if the Venlafaxine (375 mg) and Mirtazapine (30 mg) combo doesn`t work, is that the doses will be swapped around. I.e. The dose of the Venlafaxine will be reduced, and the Mirtazapine will be increased.
Anyone heard of this ? Could it work ? (Sounds spurious to me.)
Any answers gladly received.
Ta,
Anna.
Posted by sweetmarie on June 29, 2001, at 12:20:38
In reply to Re:Efexor/Remeron - Forgot To Ask, posted by sweetmarie on June 24, 2001, at 11:29:45
I haven`t received any replies to this post, so I`m re-posting it in the hope that someone can enlighten me. >
> I forgot to ask -
>
> The next line of attack if the Venlafaxine (375 mg) and Mirtazapine (30 mg) combo doesn`t work, is that the doses will be swapped around. I.e. The dose of the Venlafaxine will be reduced, and the Mirtazapine will be increased.
>
> Anyone heard of this ? Could it work ? (Sounds spurious to me.)
>
> Any answers gladly received.
>
> Ta,
>
> Anna.
Posted by teddy bishop on August 21, 2001, at 2:11:00
In reply to Re: treatment resistant depression, posted by JohnL on March 8, 2001, at 17:35:42
> I sound like a broken record because I say this so often, but as I see it there are a small handful of drugs that could prove very helpful to you. None of them have yet been tried. The only reason I suggest these drugs is because they have proven to be helpful to quite a few folks here that have had trouble with more straight forward treatments. Including me.
>
> The broken record drugs I'm referring to are Zyprexa, Amisulpride, Adrafinil, Risperdal, or any combination of two of them (not Zyprexa+Risperdal together though). Any of them, or any combination of them, seem to work especially well with a little bit of an SSRI in the background.
>
> The drugs you are on or have tried are far more harsh than any of these drugs I've mentioned. Since you can handle the side effects of the other drugs, then the ones I mentioned will seem like candy. Except for one thing. They will probably work.
>
> There are various theories as to what causes depression. The most popular one is a deficiency in neurotransmitters. Increasing them is what antidepressants do. You have pretty much exhausted that theory in your case. Time to explore other ones. That's where the drugs I mentioned come into play.
> John
Posted by Raffa on March 13, 2003, at 5:13:35
In reply to Re: a what? » Dr. Bob, posted by sweetmarie on April 15, 2001, at 15:41:04
I've been used for over 4 years denibam pharma to cure my depression with anxiety two months ago I've been experienced that I coudn't get a full erection in the evening with my girl .... so the psychiatry who helps me have suggested to make a wash out with liposom forte and e vitamins but the problems have come again
so he has suggested to use efexor now are only two days I take efexor but I'm charging of all the old fears I had. My problems had become when I was about 15 years and my father dead I had a panic attack and next depression ....
only recently with denibam I found calm and I live a life more significant ....
can you help me ?
Posted by fanni on May 8, 2003, at 16:06:29
In reply to Re:Treatment Resistant Depression - Efexor/Remeron » Wendy B., posted by sweetmarie on June 22, 2001, at 14:25:15
my srink just switched me to efexor today and i feel like ive done ten e,and as sick as a dog!!! im sick of stpid drugs,does anything actually work?!
Posted by kalyb on May 9, 2003, at 14:46:04
In reply to madoutof it on efexor, posted by fanni on May 8, 2003, at 16:06:29
> my srink just switched me to efexor today and i feel like ive done ten e,and as sick as a dog!!! im sick of stpid drugs,does anything actually work?!
You're not alone... I took my first dose of Efexor yesterday and I know what you mean. I found this board about an hour afterwards and have been reading ever since!!
I took my dose, 75mg (normal, not XR) at 10pm last night and almost immediately felt like I was "coming up" on Ecstasy (something I dabbled in years ago but no longer). I don't know if I slept last night, it felt like I didn't, as my brain was dreaming just like it does when you're on E, even though I may have still been awake.
All today I have felt totally weird. I finally worked out my body was undergoing severe anxiety symptoms - nausea, butterflies, tight head, shaking, sweating - but my brain was doing the opposite. I felt alert, but glassy and brittle, as if the world was too brightly lit. But no anxiety, which for me is like a holiday - I've been tormented by anxiety for weeks, continually recycling depressive sad thoughts that I simply could not switch off. I felt less at odds once I worked out the brain/body disconnection, most of my disorientation was the weird contrast of having my mind at a pole from my physical feelings: having more physical symptoms of anxiety than usual but actually not feeling a thing, mentally.
Some of it may have been lack of sleep, or that could have accentuated it. I decided to have a lie-down at 6pm tonight and I *think* I drifted off into a nap - woke feeling calmer and more "united". I just hope that nap doesn't stop me getting to sleep later. I think I shall take tonight's dose at 10pm again, and hope that in time I can either sleep regardless or manage to move the dose.
But yes - I have felt really like an E high today. I don't think it will last - it will level out - I think it's the initial effect of having my seratonin/other levels "messed with" by something. I seem to recall something like this with my first Prozac dose and definitely with Celexa, but in the case of those two drugs, I still had mental anxiety (which felt worse, but less E-like). Neither of these worked for me since they didn't address the anxiety, but despite the weirdness of today, my first Efexor day, I am feeling positive about it. Please cross your fingers that it works for me!!
And fanni, keep posting, I'd like someone to compare notes with, I want to hear if it settles down for you?
Posted by denise528 on May 27, 2003, at 15:11:15
In reply to treatment resistant depression, posted by sweetmarie on March 7, 2001, at 14:29:45
.
Posted by gingee on July 14, 2004, at 9:51:55
In reply to Re: treatment resistant depression sweetmarie, posted by sweetmarie on March 9, 2001, at 19:29:50
i have depression and anxiety for almost 4 years. I have been on all the SSRI's and trying a tricylic now. I have ECT which didn't work. I had a vagual nerve stimulator place in me, but it malfunctioned. was removed 3 weeks later. I also have a seizure disorder. I need help, ive been to so many drs. they dont know what to do. I live in delaware, no good psychiatrist here. what are my options.
Posted by Hopeful at last on February 5, 2005, at 20:55:35
In reply to treatment resistant depression, posted by sweetmarie on March 7, 2001, at 14:29:45
Hi - I wanted you to know that I Definitely know how frustrated, defeated and sick you must be feeling. I have had treatment resistant depression for three long years and have been on dozens of antidepressants and cocktails with augmentations. Nothing helped and I began to have thyroid, adrenal and other underactive medical stuff. No endocrinologist would treat me, and I could not even wake up in the morning!
I had almost lost all hope - when I made a special trip to Boston - Massachusetts General has the number one center for Treatment Resistant depression. Cutting edge clinicals and experts on just what is wrong with people like you and me. My first thought for you is that these doctors put us on so MANY different meds, we don't know what the heck is happening inside us!
I had a 90 minute consultation with one of their doctors. I had to "recreate" in list form, ALL the different combinations and protocols I had been on for almost three years that did not work.
I had to have my pharmacy fax me my bills - it was 11 pages long!! But this doctor recommended a protocol (Cymbalta, Cytomel, and desipramine) and I am afraid to even say this - but I feel a little better...! I am doing more things alone, not quite as tired and feel as if the "cloud that I have been living under" might be starting to lift. Of course, it is always one step forward, two steps back. But do not give up!!! If you can get up to Boston - it may be the best thing you ever do (it was for me). Good luck and be your own advocate when it comes to your meds. If something is not working you don't need one or two months to know it IS NOT working, right?I hope this helps you feel a bit less alone..
Posted by SLS on February 8, 2005, at 6:57:42
In reply to Re: treatment resistant depression, posted by Hopeful at last on February 5, 2005, at 20:55:35
Hi.
I am so heartened that someone who has been so treatment-resistant could find relief. I have treatment bipolar depression.
Were you an inpatient at Mass. General?
Did they tell you what drugs you were taking?
Thanks.
- Scott
Posted by denise1904 on February 8, 2005, at 10:14:30
In reply to Re: treatment resistant depression, posted by Hopeful at last on February 5, 2005, at 20:55:35
Hi Hopeful at last,
Thanks for letting us know, I'm so pleased for you and for myself in a way because It gives other people with Treatment Resistand Depression hope too.
Can I asked you if you've posted on this board before and if so what name did you post under when you weren't Hopeful?
Denise
This is the end of the thread.
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