Posted by Pfinstegg on October 15, 2002, at 18:08:17
In reply to Re: Nardil and the end of a long road - Blah, posted by Blah on October 15, 2002, at 9:54:16
Hi...reading these posts every few days, I just a few moments ago became aware of how extremely difficult and serious your situation is; it seems as though you have spent 23 years of your still young life in an all-out effort to undo the damage done to you by the emotional abuse you suffered, and without success so far- I can't imagine anything more discouraging. And when you are trying this hard, and still having to cope with so much pain, it's inevitable that you are not going to have the energy to grow socially and academically the way you would like to. Something in your posts have given me the feeling that you are a really good guy with a lot of potential and valuable things to offer others. As you know better than any of us, therapy can help you find these things out for yourself, build a healthy relationship with your therapist that will help you grow, and begin to put new, better ways of relating to people into action, but only if you are not too depressed to engage in therapy enough to accomplish any of these things. If your pain is just too severe to be able to do that,it's just one more failed endeavor. It sounds to me as if you are so down now that you need to do something else first. I don't mean that you should stop seeing your therapist; it's just that, while you keep seeing her, I think you need to investigate what neurophysiological treatments might be available to you.
To go over everything I am aware of:
1. CRH and Substance P antagonists- these are only in Phase 2-3 studies; I think they are going to be very helpful, but it sounds to me that the ones which have looked safe may not be very effective, and the more effective ones are not known to be safe yet. They would not be my first choice as a trial this year.
2.ECT and rTMS- ECT is very scary to contemplate, although many people are reporting good results and manageable memory deficits which last months but are not permanent. I know two people well who have had it- they had psychotic, suicidal depressions; they have both remained well for many years, and are both academics and writers- no memory deficits allowed in their fields! Once in a while, someone reports a bad experience. I would keep this open as an option. The rTMS is still experimental, so in order to get it you would have to join a study, with the possibility of getting sham treatment. Apparently, those given sham treatment during the trial are offered the real thing immediately afterwards. The preliminary reports I have read indicate that it is easy to undergo, comparable in results to ECT, and is without any memory impairments. You do have the hassle of being in a study. My psychiatrist said that she has had personal experience of two patients, both extremely drug-resistant, who had very good results with the rTMS.
3.Cortisol antagonists. You first need to know your morning and evening cortisol levels, your 24-hour urinary cortisol, and whether or not you suppress normally after a 1 mg. dose of dexamethasone. In long-standing depression, about half of the people tested will have cortisol abnormalities. It's not tested for much, because there isn't yet a good treatment. Various supplements are supposed to lower them a little, but I think the only available treatment is RU-486- mefipristone. It was "fast-tracked" by the FDA as an effective treatment for serious depression in August- it really normalizes the cortisol. There are large studies going on at Stanford and NIH; for psychotic monopolar depression at Stanford and bipolar at NIH. But this drug is in an unusual position, as it's known to be safe for abortions, and has been used millions of times. The dosage being used in the studies I mentioned is 600 mg. daily for 7 days. If you are interested, you could consult an endocrinologist and ask for "compassionate use" permission. You can't get this drug from a pharmacist, but only from a doctor who has registered with the drug company, which is Danco.
Severe depression can alter one's perception of themselves and the way they relate to the world to an incredible degree. Even through these posts, I am seeing a much different person from the way you describe yourself. Do try to hang on and look into the things I have mentioned which may seem appropriate to you, as well as others I may not know about. Also, please keep posting to us- say anything at all, but just keep in touch.
Pfinstegg
poster:Pfinstegg
thread:117296
URL: http://www.dr-bob.org/babble/20021012/msgs/123811.html