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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by dondon on August 23, 2006, at 22:15:52
In the past the only combo that worked for me was Paxil, wellbutrin and lamictal. It no longer works and i have tried several other combos and nothing works.
I was on:
-celexa, zyprexa
-effexor, remeron
-zoloft, remeron, risperdal
-wellbutrin, remeron, seroquel
-paxil with just about anything else
Posted by Phillipa on August 23, 2006, at 23:11:51
In reply to treatment resistant depression ...what works?, posted by dondon on August 23, 2006, at 22:15:52
I must sound like a broken record by now but have you considered EMSAM the new transdermal patch? Love Phillipa
Posted by finelinebob on August 23, 2006, at 23:31:57
In reply to treatment resistant depression ...what works?, posted by dondon on August 23, 2006, at 22:15:52
TCAs. Nortriptyline or imipramine might be good choices. YMMV
Posted by lymom3 on August 24, 2006, at 4:54:21
In reply to Re: treatment resistant depression ...what works?, posted by finelinebob on August 23, 2006, at 23:31:57
I'm going to throw something out there for consideration. I have/had been told for 20 years that I had trd. I was on a total of 14 anti depressants...including Emsam. Nothing worked. Sometimes I felt marginally better than others. Some meds were disasters (Cymbalta, Wellbutrin were the worst). Then I got this new pdoc (who happens to be my sons pdoc...former head of psychiatry for a major teaching university in Missouri where I live). He looked at me and asked me if any of those meds ever actually made me feel better because in the time that he had been treating me he sure didn't see that I was feeling any better. I even tried a period with no meds...that certainly proved to me that SOMETHING was not right with me. Now I am being dx'd as BP II and treated with BP meds...Topamax and Lamictal. Can't take a high dose of Lamictal because of se's so I'm taking Topamax with it. An amazing thing has happened since I increased my Topamax dosage....I feel calm. I don't cry, I don't rage. I can joke with people. My kids don't make me slam doors or yell at them anymore. I'm not saying that is your answer but if trd is your dx right now and one combo that was working included Lamictal...consider at least BP drugs or BP dx....
Posted by jealibeanz on August 24, 2006, at 10:29:11
In reply to Re: treatment resistant depression ...what works?, posted by lymom3 on August 24, 2006, at 4:54:21
LyMom,
You say you had no response to SSRI/SNRI's at all? My experiences haven't been great. But I experienced major apathy with Effexor. That basically is an antidepressant response, right. Before I was in a huge depression and had a ton of an anxiety. It brought me out of that period, but I D/C'd due to side effects and did not care for extreme lack of emotion!
Posted by Racer on August 24, 2006, at 10:54:23
In reply to treatment resistant depression ...what works?, posted by dondon on August 23, 2006, at 22:15:52
>
> I was on:
> -celexa, zyprexaAn SSRI and an atypical antipsychotic...
> -effexor, remeron
SNRI and one that's basically a new class...
> -zoloft, remeron, risperdal
'Nother SSRI, Remeron, and another antipsychotic...
> -wellbutrin, remeron, seroquel
More new stuff...
> -paxil with just about anything else
>
Yet another SSRI...There's a pattern here: You've only ever been on the newer classes of drugs. You haven't tried the older drugs -- TCAs, despite the problems associated with them for some people, are very effective medications. As are MAOIs.
Personally, I would not jump for an MAOI. My T would yell and swear at any doctor who tried to prescribe one to me, because of my eating disorder, anyway. They're out there, I know they're out there, and if need be I'll consider them. But I'd certainly suggest trying a TCA first.
As far as TCAs go, nortriptyline and desipramine are probably the kindest of them. They're well worth talking to your doctor about.
Hope that helps.
Posted by Racer on August 24, 2006, at 10:56:11
In reply to Re: treatment resistant depression ...what works?, posted by jealibeanz on August 24, 2006, at 10:29:11
> My experiences haven't been great. But I experienced major apathy with Effexor. That basically is an antidepressant response, right.
I hope you're being sarcastic there, because that really isn't an antidepressant response...
It irritates me beyond belief that so many doctors will say, "Oh, finally something works for you!" when all that's really happening is that someone is flattened out by a drug. They should be sentenced to a year of flattened emotions themselves.
I'm sorry you haven't had better luck.
Posted by jealibeanz on August 24, 2006, at 11:44:43
In reply to Re: treatment resistant depression ...what works? » jealibeanz, posted by Racer on August 24, 2006, at 10:56:11
No, I was being serious. I realize apathy is an unwanted side effects. I guess my point was that something did happen... I had a side effect! One that got rid of the depression. Not idea, but it alllmost did what it was supposed to.
You mentioned TCA's before MAOI's. Why do doc's feel this is the correct order? It's not like TCA's are without great side effects. I refuse to ever consider one, if offered, because of the weight issue. Even MAOI's carry that risk, but not as much as tricyclics.
Posted by SFY on August 24, 2006, at 14:03:34
In reply to Re: treatment resistant depression ...what works?, posted by jealibeanz on August 24, 2006, at 11:44:43
> You mentioned TCA's before MAOI's. Why do doc's feel this is the correct order? It's not like TCA's are without great side effects. I refuse to ever consider one, if offered, because of the weight issue. Even MAOI's carry that risk, but not as much as tricyclics.
While TCAs can have serious side effects, they don't have the potential for hypertensive crisis that exist with MAOIs. Also the weight gain issue isn't so clearcut. I gained weight while on Nardil and have lost weight while on Nortriptyline.
Posted by Racer on August 24, 2006, at 15:17:49
In reply to Re: treatment resistant depression ...what works?, posted by jealibeanz on August 24, 2006, at 11:44:43
> No, I was being serious. I realize apathy is an unwanted side effects. I guess my point was that something did happen... I had a side effect!
OK. I was thinking that you might not realize that that *isn't* what it's supposed to do... (Some doctors seem to accept that as "good enough," and tell their patients the medication is working as it should, when in fact it's only flattening them, which it shouldn't be doing.) I'm sorry that's the best it did for you...
>
> You mentioned TCA's before MAOI's. Why do doc's feel this is the correct order? It's not like TCA's are without great side effects. I refuse to ever consider one, if offered, because of the weight issue. Even MAOI's carry that risk, but not as much as tricyclics.There's the weight issue, but Nardil at least carries that, too. More so, on average, than nortriptyline or desipramine.
The big problem, though, with MAOIs is the dietary restrictions. It's a choice that can be made, but for a lot of people the dietary restrictions are too much of a sacrifice. What's more, the consequences of slipping up can be severe. Some people might think the MAOIs are a better second line class than TCAs, but I think many people would go for the TCAs first, because they don't come with the hypertensive/dietary issues.
And, honestly, it seems as though they *all* cause weight gain.
Again, my opinions, nothing more...
Posted by finelinebob on August 24, 2006, at 19:54:26
In reply to Re: treatment resistant depression ...what works?, posted by jealibeanz on August 24, 2006, at 11:44:43
> I guess my point was that something did happen... I had a side effect!
It always has seemed to me that one drug's side effects are an indication that it's treating what you don't have. Conversely, if a drug treats what you have, you won't necessarily see the side effects -- the same mechanism for you might be the main effect of the med.
> It's not like TCA's are without great side effects. I refuse to ever consider one, if offered, because of the weight issue.
SSRIs gave me an extra 30lbs. Being on Notriptyline hasn't helped me lose any, but I haven't gained any more. No constipation. Can't say about the sun sensitivity -- I burn in 5 minutes anyway. What nortriptyline has done that no SSRI did was raise my baseline mood considerably. Not enough, I've needed to augment. But when you find a med that addresses your depression, you WILL recognize the difference.
Posted by Phillipa on August 24, 2006, at 20:16:28
In reply to Re: treatment resistant depression ...what works? » dondon, posted by Racer on August 24, 2006, at 10:54:23
No TCA's for me. From what I've seen they cause massive weight gain. I was a volunteer and watched a petite girl blow up over three weeks on TCA's and her diet was controlled. So unless I was suicidal I wouldn't consider them. I'd rather stay the way I am . As weight gain at my age is simply dangerous. Love Phillipa
Posted by psychobot5000 on August 24, 2006, at 22:28:17
In reply to treatment resistant depression ...what works?, posted by dondon on August 23, 2006, at 22:15:52
Hi,
A few more names of drugs you might try:
Tricyclics:
* amitriptyline (Elavil))
* clomipramine (Anafranil)
* desipramine (Norpramin)
* doxepin (Adapin, Sinequan)
* imipramine (Tofranil)
* nortriptyline (Pamelor)
(there are others, too. They are effective drugs.)or
The MAO inhibitors phenelzine (Nardil), or tranylcipromine (Parnate), or selegiline (deprenyl, EMSAM). The first two are especially helpful in treatment-resistant depression, but carry strict dietary restrictions.
I hope something works out for you.
Pbot
Posted by Emily Elizabeth on August 25, 2006, at 0:17:42
In reply to Re: treatment resistant depression ...what works?, posted by finelinebob on August 24, 2006, at 19:54:26
Just wanted to say that I didn't gain at all on desipramine. It did help some, but it wasn't my magic bullet. I would encourage others to give it a try.
Also, it is my impression that what causes weight gain for person A might not for person B, but person B might gain on something that person A does not. So, if you are suffering, it is probably worth a shot to try a TCA. If you begin to gain weight, it is easy enough to stop.
Best,
EE
Posted by linkadge on August 25, 2006, at 20:26:01
In reply to Re: treatment resistant depression ...what works? » Racer, posted by Phillipa on August 24, 2006, at 20:16:28
TCA's vary greatly in their capacity to cause weight gain. Amitryptaline and doxapin probably cause the most wheras things like desipramine probably don't cause much at all.
They're such a diverse class its hard to lump them all together.
Linkadge
Posted by Phillipa on August 25, 2006, at 22:28:08
In reply to Re: treatment resistant depression ...what works? » Phillipa, posted by linkadge on August 25, 2006, at 20:26:01
Thanks Link. Love Phillipa
Posted by Morhoun on August 26, 2006, at 10:38:06
In reply to treatment resistant depression ...what works?, posted by dondon on August 23, 2006, at 22:15:52
> In the past the only combo that worked for me was Paxil, wellbutrin and lamictal. It no longer works and i have tried several other combos and nothing works.
> I was on:
> -celexa, zyprexa
> -effexor, remeron
> -zoloft, remeron, risperdal
> -wellbutrin, remeron, seroquel
> -paxil with just about anything else
>Buprenorphine. Search the archives for info.
Posted by Morhoun on August 26, 2006, at 10:42:30
In reply to treatment resistant depression ...what works?, posted by dondon on August 23, 2006, at 22:15:52
> In the past the only combo that worked for me was Paxil, wellbutrin and lamictal. It no longer works and i have tried several other combos and nothing works.
> I was on:
> -celexa, zyprexa
> -effexor, remeron
> -zoloft, remeron, risperdal
> -wellbutrin, remeron, seroquel
> -paxil with just about anything else
>
Also, you might try picamilon. I haven't had much luck with typical ADs either. I recently started Picamilon and it's helped considerably but I'm getting some stomach upset with it unfortunately. It works great for a lot of people though.I also had sucess with Adderall (a stimulant normally used for ADHD) for my depression but it takes away the appatitie which isn't good for me so I quit it. Other alternatives...Strattera or Buspar which I haven't tried but for some people it's the magic bullet.
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