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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by courtfield1974 on February 13, 2012, at 0:24:51
I started having suicidal ideation in 1st grade,,,no trauma, bad genes. TONS of depression/suicide in my family! i recently heard about endorphin deficiency syndrom and opiate deficiency can make this type of depression much worse! any meds reccomended for this type of depression. I've done ECT a lot, but it's just a quick fix. cymbalta was good for about 6 months before it pooped out! need rec quick...have to have fully hysterectomy in a week, due to dumb negligence of my obgyn that lead to treatment resistant infection that is killing my reproductive system and causes severe 24/7 PAIN since June 2011 laparoscopy surgery for ovarian mass (benign) any good off label meds? my psychiatrist is open to off label meds!
Posted by Laney on February 13, 2012, at 11:14:11
In reply to best med for endogenous depression, posted by courtfield1974 on February 13, 2012, at 0:24:51
I don't have any answers for your questions but I was just wondering how it was for you to withdrawl from Cymbalta?
Someone will hopefully come along soon that can help!
Laney
Posted by bleauberry on February 13, 2012, at 12:13:19
In reply to best med for endogenous depression, posted by courtfield1974 on February 13, 2012, at 0:24:51
My opinion your best choices are:
Nortriptyline+Zoloft
Nortriptyline+Prozac
Nardil
ParnateOf that list I favor the first one because of the inherent built-in pain relief and sleep aid from nortriptyline.
Cymbalta is touted as a SNRI, which it really isn't. For a true SNRI that can be custom tailored to you, Nort+Zoloft does that, and comes with pain relief as a side benefit.
Treatment resistant infection is a lame excuse for them to use. It simply means they haven't used the right stuff. The stuff they thought was appropriate didn't work, in other words. The stuff they didn't think was appropriate just might work miracles. Look no further than Lyme wars to see that scenario in play. People can fail one anti-infectious agent after another, dozens of them, and then land on a miracle, usually something that really didn't seem to make much sense at the time. Not to mention, when someone combines some of the common Lyme herbs with anti-infectious meds, the meds become much more effective. It is also a common flaw to think we know what the infection is....bacterial or whatever. In Lyme wars, we see Bartonella go away with meds that are not known to hit Bartonella. We see Lyme symptoms go away with things that aren't even antibacterial at all, such as Diflucan. How do we know that infection isn't some occult version of a fungi or mold or some bizarre strain of bacteria? We don't. There is no way to accurately test. If they are basing treatment purely on tests, your odds of success drop significantly. So when they say the infection is treatment resistant, I totally disagree. They only scratched the surface.
Posted by jono_in_adelaide on February 13, 2012, at 16:05:07
In reply to best med for endogenous depression, posted by courtfield1974 on February 13, 2012, at 0:24:51
Sertraline (Zoloft) 50mg in the morning
plus
Welbutrin XL 300mg in the morning
or
Nortriptyline 75mg at bedtime
Posted by SLS on February 13, 2012, at 16:25:27
In reply to Re: best med for endogenous depression, posted by jono_in_adelaide on February 13, 2012, at 16:05:07
> Sertraline (Zoloft) 50mg in the morning
>
> plus
>
> Welbutrin XL 300mg in the morning
>
> or
>
> Nortriptyline 75mg at bedtime
I like that.
- Scott
Posted by Christ_empowered on February 13, 2012, at 18:58:14
In reply to best med for endogenous depression, posted by courtfield1974 on February 13, 2012, at 0:24:51
stimulant+tca+therapy
Posted by Laney on February 14, 2012, at 11:47:29
In reply to Re: best med for endogenous depression, posted by Christ_empowered on February 13, 2012, at 18:58:14
CE,
Why a stimulant instead of an SSRI? Isn't it pretty hard to get a doctor to prescribe stimulants?
Thanks!
Laney
Posted by uncouth on February 14, 2012, at 13:25:49
In reply to best med for endogenous depression, posted by courtfield1974 on February 13, 2012, at 0:24:51
court i still think you should pump up the cymbalta dose to 120mg and try the LDN for endorphin deficiency! if you never have tried a TCA nortryptiline would be a good choice, even if wellbutrin caused bad reaction nortryptiline could work. i can't remember if you ever said you've tried nardil or parnate...parnate plus stimulant is known to work in really resistant cases. also check out the posts here about ketamine, there are a bunch of people talking about it, and it looks like there are two doctors here who are doing it:
http://archpsyc.ama-assn.org/cgi/eletters/67/8/793
you are definitely a candidate.i wish your doctor would be ok with you trying DHEA...i think its really underused as an adjunct and helps regrow brain cells just like ketamine does.
otherwise i remember one time a few years back my doctor said he had actually had some success COMBINING effexor and cymbalta. if i remember correctly effexor has some opioid-related action too.
i think you should ask dr. h. about low dose selegiline + DLPA...i think it was dr. h (it might have been the other integrative MD) who told me on the hush that that is what she used to treat her own depression one time. i don't know if its super powerful but selegiline plus DLPA is a sure route to increasing PEA...the stuff I was taking 18 months ago in higher doses directly that landed me in ST.
anyway...keep posting on psychobabble i've found it to be a great resource with really great people...one of the only places where you can talk frankly and are guaranteed to find people who understand.
talk to you soon.
-a
Posted by SLS on February 14, 2012, at 13:45:11
In reply to Re: best med for endogenous depression » courtfield1974, posted by uncouth on February 14, 2012, at 13:25:49
Can someone please direct me to where I might find information that indicates that endogenous/melancholic depression occurs as the result of opioid dysfunction?
Thank you.
- Scott
Posted by Christ_empowered on February 14, 2012, at 14:42:28
In reply to Re: best med for endogenous depression, posted by SLS on February 14, 2012, at 13:45:11
I've tried Tofranil (old school TCA) plus Adderall (amphetamine), and it worked nicely. I became a bit angry, but whatever--I guess that means its working, right?
Anyway, TCAs are supposedly good for more severe, endogenous depressions when other drugs have failed. Stimulants help put "pep in your step" and can counteract some of the weight gain and sedation from many TCAs (I only gained 5lbs on full dose Tofranil-PM, for instance). The downside is that TCA drugs can increase speed concentrations in your brain, which can be good or bad, depending on your situation and how well calibrated the doses of both drugs are.
I imagine there'd be some cardio concerns, too. Stimulants are still used "off-label" for depression, fatigue, etc. I don't know if its easy or hard to get a doc to go for it. I think if you can outline a rational argument and you're not a drug seeker and you don't have a personality disorder, it wouldn't be that big a deal. Then again..I'm not a doctor.
I just think-- based on my experience, not medical training of any sort--that you can only get so far with reuptake inhibitors. I mean, AD plus AD plus antipsychotics plus anticonvulsants. It gets ridiculous after a while. At least stimulants make you feel better and work quickly to get you out of bed.
Of course, I don't need all that anymore. Maybe its brain damage, maybe its the Abilify, maybe its God...I do reasonably well on Abilify, sometimes with an antidepressant or lamictal in the mix.
This is the end of the thread.
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