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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Meatwood_Flack on February 26, 2013, at 10:25:08
I see my pdoc tomorrow afternoon (10 weeks between appointments is ridiculous) and the regime he started me on in December isn't working. I am currently taking Prozac (20 mg. per day) plus Wellbutrin (300 mg.) per day and up to 150 mg. of Trazodone for sleep. I had been on Wellbutrin at 150 since June with no results. All it seems to do us interfere with sleep (already insomniac.) I've previously tried Zoloft up to 150 mg., Effexor up to 125 mg., Cymbatla up to 120 mg., Buspirone, Abilify up to 10mg., I think BuSpar may have been 100 mg., Lamictal, I think it was 100 mg. as well. Had also taken low dose Mirtazapine (7.5 mg.) and 150 mg. Quietapone until taken off it due to myoclonic jerks (which, I actually still get, but only when trying to sleep, besides an occasional, involuntary quick turning of the head as though I'm trying to focus my eyes (hope it's not tardive.) MAOI's are not an option where I am being treated and he seemed hesitant to give me a TCA due to overdose potential (though I don't know that he wouldn't change his mind.) Any ideas to share tomorrow would be appreciated. I've read where SSRI's aren't effective for melancholic depression, and the fact that I have tried Zoloft, Effexor, Cymbalta and now Prozac makes me doubt that not having enough serotonin is my issue...
Posted by bleauberry on February 26, 2013, at 15:27:44
In reply to Melancholic depression, posted by Meatwood_Flack on February 26, 2013, at 10:25:08
You are probably correct, in my opinion, that serotonin is not the primary issue, and anything that is primarily a serotonin med is not going to work.
The melancholic side of things usually comes from something wrong in the norepinephrine/dopamine circuits. If anything is low, it's one of those. Prozac actually wasn't a bad choice, but it needed to be a low dose and needed a TCA or stimulant with it. Same for zoloft. All the others you've tried, forget it, that was fairly predictable.
You can try some easy cheap stuff that has the potential to work wonders. Rhodiola rosea is at the top of the list for that. Combines well. You could also try supplementing the precursors that make NE/DA, such as tyrosine and/or dlpa. Those are hit and miss, sometimes work like miracles, sometimes not helpful at all. Rhodiola is good.
In any case, if a med is going to favor serotonin, or is going to block receptors, it is probably not going to help melancholic symptoms and likely make them worse. So whether you take a look at any of the above suggestions or not, at least you know what to look for.
Posted by Phillipa on February 26, 2013, at 15:54:55
In reply to Re: Melancholic depression, posted by bleauberry on February 26, 2013, at 15:27:44
Effexor? Phillipa
Posted by Meatwood_Flack on February 26, 2013, at 16:06:45
In reply to Re: Melancholic depression, posted by bleauberry on February 26, 2013, at 15:27:44
Thanks, definitely some things to consider. Do you know if Rhodiola has benefits for severe depression? All the info. I've found online mentions mild to moderate. After 13 months of this I would take mild depression in a heartbeat and would consider moderate, if there were no other options. The anhedonia and lack of energy are probably the most distressing symptoms. If I could enjoy anything I might not have the persistent low mood. Once upon a time I could alleviate low moods by playing guitar or writing or hanging out with friends. None of that works anymore, and actually feels foreign and, thus, assures that the mood stays low.
Posted by Meatwood_Flack on February 26, 2013, at 16:10:07
In reply to Re: Melancholic depression, posted by Phillipa on February 26, 2013, at 15:54:55
Tried it for several months and didn't even get any noticeable side effects.
Posted by CamW on February 26, 2013, at 17:00:02
In reply to Melancholic depression, posted by Meatwood_Flack on February 26, 2013, at 10:25:08
Meatwood Flack
It seems that you have given the serotonergic antidepressants a fair try, so you might need the broader spectrum antidepressants; MAOIs or TCAs, but they have either dietary restrictions, or nastier side effects than the TCAs. Perhaps mention Manerix (moclobemide; not sure of US brand name). might be a choice.
Since you have given Effexor (venlafaxine) a try without success, perhaps other norepinephrine reuptake inhibitor like Cymbalta (duloxetine; again, not sure of US brands) or a TCA like desipramine might be options.
For severe melancholic depression, I have seen some good results with ECT, but many docs use that as a last resort.
These may be some options to discuss with your doctor.
- Cam
Posted by Meatwood_Flack on February 26, 2013, at 19:01:13
In reply to Re: Melancholic depression » Meatwood_Flack, posted by CamW on February 26, 2013, at 17:00:02
The MAOI and ECT aren't options through my provider but will mention the other ideas. Thanks.
Posted by Meatwood_Flack on February 26, 2013, at 19:03:11
In reply to Re: Melancholic depression, posted by Meatwood_Flack on February 26, 2013, at 19:01:13
The MAOI's and ECT aren't options through my provider but I will mention the other ideas. Thanks.
This is the end of the thread.
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