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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Jerrympls on November 7, 2002, at 22:58:10
I'm only on a small dose of Lamicatal - I think I am taking 25mg twice daily. I noticed some werid irritability and "bad mood" when i started it. Then after a couple weeks I was to go up to 50mg twice daily. Well, I think Monday was when I started uping the dose - I took 50mg in the morning and went to work. At first I was really irritable. Then - for the rest of the day the psychological pain was almost to the point of unbearble. I could only think of killing myself to end the pain. I hated everything and everyone. I had to hide in the men's room at work to cry.
How long will it go on that pdocs prescribe me meds that consistantly do not work, only cause side effects, worsen my condition, kill my sex drive, kill my passion for music (among other things), make me stupid, irritable, unable to sleep, or sleep too much, increase anger, - etc etc etc.
Don't get me wrong - my current pdoc is great and he's the best I've ever had. But, nothing is making me better - after 11 years - nothing. ECT, experimental treatments, antipsychotics, combination treatments, talk-therapy, cognitive-behavioral therapy......
No medication....lots of medication - it's consistantly the same thing.
Why don't they hear me when I tell them corticosteriods erase my depression within 3 days? Or that hydrocodone works well and has lkept me able to move to a new state and hold a job....why do they turn off their ears and hide their eyes??
I know that most of my past docs and my current doc have done or are doing the best they can with my frustrating case - and I am forever gratefull. But I can no longer think that a different SSRI plus a different antipsychotic will work when it didn't work the 1st-5th times.
I just can't imagine things getting any better anytime soon.
I no longer want all of life's pains, and none of life's pleasures.
Who shall I pray to? God? Been there -done that - and nothing. Should I join a cult? How about be cured by Dr. Phil? Maybe one of Oprah's books will cure my ills? Street drugs? nah. Hmm..what else? Become a vegetarian? Have all my fillings replaced? Sit in front of a light box? Keep a journal describing hell on earth everyday? Watch a funny movie? Supplements? L-tryptophan? Magnets on my head? Implant in my chest? Hormones? Hobbies? Set goals? Lose weight? Walk in front of a bus? Co2? Jump off a bridge? Write my parents a letter about how they ruined my childhood? Write myself a letter about how I've had no life for the past 11 years? Maybe watch the Ana Nicole show marathon? By the way - how come she gets unlimitied access to vicodin and she has no ailement? Perhaps I should not wear underwear to work tomorrow? Perhaps I should stop going to work? Stop calling friends? Stop answering my phone? Close the shades and hope life doesn't find me?
All of life's pains....none of life's pleasures.
To be....or not to be.
Posted by Pfinstegg on November 8, 2002, at 9:51:48
In reply to Lamictal is making me suicidal, posted by Jerrympls on November 7, 2002, at 22:58:10
Hi.. I'm so sorry to hear how hard things are. One thing you said jumped out at me: that the depression clears when you take corticosteroids. I know you can't take them for an extended period because the physical side effects become very dangerous, but it gives a real clue as to what is wrong: you must have the type of depression that is caused by (or follows?) HPA axis dysregulation. If this is so, you would have non-suppression on the DST suppression test, excess 24-hour urinary cortisol, and probably a number of other abnormalities, such as slight thyroid dysfunction and a smaller-than-normal hippocampus. The hard thing about looking at depression from this point of view is that, while it is physiologically correct, it is very difficult to know what to do.
I have this exact type of depression, and have not been helped very much by any SSRIs or psychotherapy. I am in the process of trying to address the underlying brain abnormality. I have found an excellent neuroendocrinologist, and have had a thorough work-up, which indeed showed an abnormally small left hippocampus on MRI, non-suppression on DST, too high 24-hour urinary cortisol and hypothyroidism.
The things we have decided to do are:
1. use tianeptine, a European anti-depressant, not so much for its AD properties, which are not huge, but for its ability to protect the hippocampus and allow it to regain normal size- this is experimental, as it has been demonstrated in tree shrews but not humans.
2. add Cytomel to synthroid supplementation- it has been shown to have an AD effect.
3. join a trial of rTMS; when it is successful, you convert back to being a DST suppressor, and cortisol levels return to normal.
This is the present plan; if these don't work, he will consider other things such as mifepristone or ketanozodole. However, he would like more time to watch the clinical trials of these things going on now. Even further on, there might be the possibility of CRH antagonists, Substance P antagonists, etc., but these are a number of years away from safe clinical use.
It was a big mental jump for me to begin looking at my MDD as a physical disorder, mainly involving my brain, but also my adrenals and thyroid. I am not well yet, and may never be, but I have improved on tianeptine and Cytomel, and am due to start rTMS on the day after Christmas.
I do hope you will find the right thing for you, and that what I have told you could be a help.
Pfinstegg
Posted by glenn on November 8, 2002, at 10:53:33
In reply to Lamictal is making me suicidal, posted by Jerrympls on November 7, 2002, at 22:58:10
Jerry, I am sorry to hear that you are having such a rough time, the one bright spot as Pfinstegg points out is that you do have a clue to your problem, and possible treatment in your rapid response to the steroids and possibly the vicodin.
Have you had the cortisol and dexamethasone tests?
they sound essential and if they prove one way or the other that you do have a problem with cortisol I'm sure Pfinstegg ,myself and others will be able to make suggestions medication and alternative wise.
I'm not so clear that long term steroid therapy is so impossible though, I think it depends upon the dosage and the efforts one puts in to minimise the known problems.
However I' sure that is something your doc can advise you on.
Best wishes.Glenn
Posted by Maximus on November 8, 2002, at 12:01:32
In reply to Lamictal is making me suicidal, posted by Jerrympls on November 7, 2002, at 22:58:10
> I'm only on a small dose of Lamicatal - I think I am taking 25mg twice daily. I noticed some werid irritability and "bad mood" when i started it. Then after a couple weeks I was to go up to 50mg twice daily. Well, I think Monday was when I started uping the dose - I took 50mg in the morning and went to work. At first I was really irritable. Then - for the rest of the day the psychological pain was almost to the point of unbearble. I could only think of killing myself to end the pain. I hated everything and everyone. I had to hide in the men's room at work to cry.
****************
Hi Jerrympls,
I'm not here to play the doctor but i just want to help. So here it goes.
I may be wrong but you sound like you're experiencing bouts of depression and mixed states.
Lamictal is activating at the begining. Thus you may have irritability, anxiety and insomnia. The trick is to increase the dose very very slowly.
Have you been diagnosed bipolar? If yes you have to be back up with a safety net, i.e., a mood stabilizer for mania. As lithium is the perfect companion of Lamictal, a non therapeutic dose of Lithium should do the work.
If you're not bipolar, you might try a low dose of SSRI with or without a small dose of clonazepam (Klonopin).
A good pdoc is always available to help. Feel free to call him/her anytime. You may need a med adjustment. A quick phone call to your drug store by your pdoc can do a whole difference.
Regards,
Max
Posted by lawrence s. on November 9, 2002, at 1:30:09
In reply to Lamictal is making me suicidal, posted by Jerrympls on November 7, 2002, at 22:58:10
> I'm only on a small dose of Lamicatal - I think I am taking 25mg twice daily. I noticed some werid irritability and "bad mood" when i started it. Then after a couple weeks I was to go up to 50mg twice daily. Well, I think Monday was when I started uping the dose - I took 50mg in the morning and went to work. At first I was really irritable. Then - for the rest of the day the psychological pain was almost to the point of unbearble. I could only think of killing myself to end the pain. I hated everything and everyone. I had to hide in the men's room at work to cry.
>
> How long will it go on that pdocs prescribe me meds that consistantly do not work, only cause side effects, worsen my condition, kill my sex drive, kill my passion for music (among other things), make me stupid, irritable, unable to sleep, or sleep too much, increase anger, - etc etc etc.
>
> Don't get me wrong - my current pdoc is great and he's the best I've ever had. But, nothing is making me better - after 11 years - nothing. ECT, experimental treatments, antipsychotics, combination treatments, talk-therapy, cognitive-behavioral therapy......
>
> No medication....lots of medication - it's consistantly the same thing.
>
> Why don't they hear me when I tell them corticosteriods erase my depression within 3 days? Or that hydrocodone works well and has lkept me able to move to a new state and hold a job....why do they turn off their ears and hide their eyes??
>
> I know that most of my past docs and my current doc have done or are doing the best they can with my frustrating case - and I am forever gratefull. But I can no longer think that a different SSRI plus a different antipsychotic will work when it didn't work the 1st-5th times.
>
> I just can't imagine things getting any better anytime soon.
>
> I no longer want all of life's pains, and none of life's pleasures.
>
> Who shall I pray to? God? Been there -done that - and nothing. Should I join a cult? How about be cured by Dr. Phil? Maybe one of Oprah's books will cure my ills? Street drugs? nah. Hmm..what else? Become a vegetarian? Have all my fillings replaced? Sit in front of a light box? Keep a journal describing hell on earth everyday? Watch a funny movie? Supplements? L-tryptophan? Magnets on my head? Implant in my chest? Hormones? Hobbies? Set goals? Lose weight? Walk in front of a bus? Co2? Jump off a bridge? Write my parents a letter about how they ruined my childhood? Write myself a letter about how I've had no life for the past 11 years? Maybe watch the Ana Nicole show marathon? By the way - how come she gets unlimitied access to vicodin and she has no ailement? Perhaps I should not wear underwear to work tomorrow? Perhaps I should stop going to work? Stop calling friends? Stop answering my phone? Close the shades and hope life doesn't find me?
>
> All of life's pains....none of life's pleasures.
>
> To be....or not to be.
>
>
Jerrympls,
I can relate to a lot of stuff you said. I too am just recovering from a lamictal trial. You described my experince exactly. Especially losing passion for music part. I also did'nt care for becoming a dimwit and losing my sense of humor either. It was the closest I have come to suicide in my lifetime. My mood would change from ok to deep, deep, despair, rage, distrust, hate. I thought I was going to hurt someone.
I have had good response to Nardil. Have you tried it yet? In my opinion it is the only antidepressant that works. all of the ssri's snri's tca's all gave me fleeting sense of releif.
I have a hunch that Nardil has some kind of action on opiate receptors. I plan to go back on it soon. I had to stop because of surgery. Believe me, giving up the cheese, wine, beer, ect. was a small price to pay for how much better I felt. My only fear is poopout, which is so common with the maoi's.
You are not alone. "Seek and ye shall find"
And when you do find, let me know!
Larry
Posted by jyl on November 11, 2002, at 10:52:55
In reply to Re: Lamictal is making me suicidal, posted by lawrence s. on November 9, 2002, at 1:30:09
Posted by BrittPark on November 12, 2002, at 23:19:26
In reply to Lamictal is making me suicidal, posted by Jerrympls on November 7, 2002, at 22:58:10
Hi Jerry,
Have you looked into tramadol at all. The reports I've seen have been mixed but It might be worth a shot. It is an opioid, albeit a week one, but is unscheduled and therefore easier to get a prescription for it.
Feel better, and remember that the magic bullet opioid may still be found.
Britt
P.S. As to the lamictal I'm sorry it's not working for you. I'm at 225mg myself, and I think it's starting to help with the vestiges of my current episode of depression. I was lucky though in that I felt absolutely no effects, side or otherwise, from it.
This is the end of the thread.
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