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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Jeroen on October 24, 2009, at 14:55:17
i'm disabled :;( trying to recover from all this :
with disabled i mean.
- cannot go outside and feel good and happy
- i do absolutelly nothing in the weekends, i want to go out and have fun, that's not happened in years- unable to get a girlfriend even my interest is high
does anyone recognize my symptoms... boy why is this seroquel a primitive defect drug, it made me feel so good and happy i could do all these things again, and now nothing.. for years...
Posted by Jeroen on October 24, 2009, at 15:17:46
In reply to i'm disabled :;( trying to recover from all this :, posted by Jeroen on October 24, 2009, at 14:55:17
memantine..... i hear this med, take it take it.... but i have manic psychosis
i do take 2 anti psychotics, maybe i should increase my abilify to 15 mg and go ahead with the memantine?
it's lithium or memantine
basically i want to eliminate the manic psychosis from my nervous system by taking high dose seroquel XR 800 MG (quoting Maxime few years ago her psychosis diminished)i dont know what type it was Maxime but you gave me hope there :)
but it may also kill me.... gottahavehope :|
Posted by bleauberry on October 24, 2009, at 15:47:16
In reply to i'm disabled :;( trying to recover from all this :, posted by Jeroen on October 24, 2009, at 14:55:17
I spent about an hour studying at pubmed to hopefully find some useful stuff for you. Here is what I discovered so far:
1. Psychotic depression is understudied and difficult to treat, thus helping to explain the tough road you have been on.
2. There are many successful outcomes of previously impossible cases...NONE of them happened until an antidepressant was used...either imipramine, amitriptyline, luvox, effexor, or zoloft...sometimes monotherapy with the AD alone, and sometimes when combined with either Risperdal, Zyprexa, or Seroquel. This is potentially very cool, because it provides you with a toolbox of the very specific meds to focus on in various combinations to duplicate what they did in hospitals around the world with patients like you. The toolbox consists of Fluvoxamine, Sertraline, Imipramine, Amitriptyline, Risperidone, Olanzapine, Quetiapine, and possible addition of Lithium to any of the combinations.
3. ECT with meds is viewed as the best course...I disagree...but certainly worth keeping on the radar screen.
4. Of the SSRIs used successfully, Luvox and Zoloft appeared the best, as you'll see below, and the theory is that it has something to do with sigma receptors.
There are more studies than just the ones I copied below, but here are a few to read. You will see a few things you have already done, so those will be easy to rule out and focus on the other things you haven't done:
Psychotic depression is frequent among hospitalized patients diagnosed with major depression. Patients diagnosed with this type of depression display a number of specific characteristics. They have a higher risk of suicidal behaviour, they have a prolonged and more severe clinical picture and subsequently they have an increased risk of relapse. Studies show that monotherapy with antidepressants is more effective than antipsychotic monotherapy. Electroconvulsive therapy remains the most effective treatment, while tricyclic antidepressants in monotherapy are also effective. An antipsychotic drug can be added if no effect of monotherapeutic antidepressant treatment is observed within two to four weeks.
PMID: 19014722 [PubMed - indexed for MEDLINE]
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.This new version of the psychotic depression algorithm has been developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. The most effective treatment modality for inpatients with severe psychotic depression is electroconvulsive therapy. The first-line psychopharmacological treatment is a combination of an antidepressant (either a tricyclic or a selective serotonin reuptake inhibitor) and an antipsychotic. If one of these combinations has failed, consider switching to the other. If both combinations have failed, the next psychopharmacological option would be to augment the combination with lithium. Another option, though with limited evidence, is monotherapy with clozapine. If there is a good reason to avoid combination therapy with an antipsychotic, then a trial of monotherapy with a TCA or an SSRI can be supported. If that fails, adding an antipsychotic or ECT should be considered.
PMID: 18661366 [PubMed - indexed for MEDLINE]
Neuroscience Education Institute, University of California-San Diego, San Diego, CA, USA.
Psychotic major depression is a severe condition that frequently proves difficult-to-treat. The most effective traditional treatments (electroconvulsive therapy and combinations of antipsychotics with tricyclic antidepressants) are associated with significant side effects, and the use of tricyclic antidepressants alone is largely ineffective. Recent evidence has indicated that the selective serotonin reuptake inhibitors, either alone or in combination with antipsychotics, may provide a desirable alternative to traditional treatments. Among selective serotonin reuptake inhibitors, fluvoxamine has been the best studied and, somewhat surprisingly, has proven effective in several studies as a monotherapy without the need to combine with an antipsychotic. It is proposed that the apparent efficacy of fluvoxamine in psychotic major depression may be related to its unique property of high affinity for the sigma 1 receptor, which is thought to play a role in psychosis and in the action of some antipsychotic drugs.
PMID: 15788959 [PubMed - indexed for MEDLINE]
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands.
Wijkstra J, Burger H, van den Broek WW, Birkenhäger TK, Janzing JGE, Boks MPM, Bruijn JA, van der Loos MLM, Breteler LMT, Ramaekers GMGI, Verkes RJ, Nolen WA. Treatment of unipolar psychotic depression: a randomized, double-blind study comparing imipramine, venlafaxine, and venlafaxine plus quetiapine.Objective: It remains unclear whether unipolar psychotic depression should be treated with an antidepressant and an antipsychotic or with an antidepressant alone. Method: In a multi-center RCT, 122 patients (18-65 years) with DSM-IV-TR psychotic major depression and HAM-D-17 >/= 18 were randomized to 7 weeks imipramine (plasma-levels 200-300 mug/l), venlafaxine (375 mg/day) or venlafaxine-quetiapine (375 mg/day, 600 mg/day). Primary outcome was response on HAM-D-17. Secondary outcomes were response on CGI and remission (HAM-D-17). Results: Venlafaxine-quetiapine was more effective than venlafaxine with no significant differences between venlafaxine-quetiapine and imipramine, or between imipramine and venlafaxine. Secondary outcomes followed the same pattern. Conclusion: That unipolar psychotic depression should be treated with a combination of an antidepressant and an antipsychotic and not with an antidepressant alone, can be considered evidence based with regard to venlafaxine-quetiapine vs. venlafaxine monotherapy. Whether this is also the case for imipramine monotherapy is likely, but cannot be concluded from the data.
PMID: 19694628 [PubMed - as supplied by publisher]
The purpose of the present study is to compare the efficacy of imipramine in the treatment of psychotic versus nonpsychotic depression. Previous studies report varying results of monotherapy with antidepressants in psychotic depression. Because psychotic depression is seriously underinvestigated, performing a post hoc analysis of randomized clinical trials consisting of both psychotic and nonpsychotic depressed patients may contribute to the discussion on the optimal treatment of depressed patients with mood-congruent psychotic features. A total of 112 patients diagnosed with major depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) (40 with psychotic depression and 82 without psychotic features) received treatment with imipramine for 6 weeks after a washout period of 7 days. Imipramine doses were adjusted to attain a predefined fixed plasma level. Treatment response was assessed with the Hamilton Rating Scale for Depression (HAM-D). A logistic regression analysis showed a significantly larger reduction in HAM-D score in the sample with psychotic features compared with the nonpsychotic sample (regression coefficient, -3.47; SE, 1.7; P = 0.04). According to the primary outcome criterion, that is, the change in HAM-D score, imipramine was significantly more effective in the sample with psychotic depression compared with the nonpsychotic depressed patients. The contradiction between our results and those of several previous studies may be due to the fixed plasma level dosing of imipramine refraining from concurrent psychotropic medication or limiting our patient sample to patients with mood-congruent psychotic features.
PMID: 18344726 [PubMed - indexed for MEDLINE]
Posted by Jeroen on October 24, 2009, at 15:51:51
In reply to Re: i'm disabled :;( trying to recover from all this :, posted by bleauberry on October 24, 2009, at 15:47:16
thanks what about adding memantine to my abilify 10 mg and seroquel XR 100 mg
i responded well to amantadine in the past... 100 mg it was and it gave a good anti depressant effect
Posted by bleauberry on October 24, 2009, at 17:41:08
In reply to to bleauberry, posted by Jeroen on October 24, 2009, at 15:51:51
> thanks what about adding memantine to my abilify 10 mg and seroquel XR 100 mg
>
> i responded well to amantadine in the past... 100 mg it was and it gave a good anti depressant effectWell, those ideas are as good as any since everything we are attempting to do is experimental anyway. It's not as if anyone has any surefire failproof way to treat anything. It's all experimental.
I limited the things I shared with you to things that have been tried and worked in hospital inpatients and that were posted on pubmed. I wanted to stick with ideas that have actually been done, tested, and reported. Rather than purely guessing.
If Amantadine helped you before, then without any hesitation I would go with that rather than Memantine. You'll know within a 1 to 3 weeks if Amantadine is a good choice or not. If not, then move to something else.
The general sense I got from pubmed is that something you have not even considered, but worked surprisingly well for others, might be highest on the list. That would probably be one of the antidepressants I listed, with Luvox looking the most attractive in the bunch. Even the authors of that study were surprised at its effectiveness in the psychotic depression population.
Again, I'm not guessing or theorizing, I am going purely on what has already been done and worked. Since everything we do is experimental, I think maybe it helps to keep our experiments close to the ones that have already been done with good results? There are no huge clinical studies on this stuff, so we have no choice except to go by the experience of smaller studies, which still seems to me better than pure guesswork.
I do honestly believe you are going to do better soon. That is because, for the first time ever, I see you willing to venture outside of the antipsychotic class. I think that is going to open up a whole new world of promise for you. Well, at least that's what the small studies saw happen.
Posted by Phillipa on October 24, 2009, at 22:38:57
In reply to to bleauberry, posted by Jeroen on October 24, 2009, at 15:51:51
Jeroen does your doc think your're depressed not? Phillipa
This is the end of the thread.
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