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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 ClearSkies on January 2, 2006, at 20:36:22
I've been severely depressed for 10 days now. Funny how it coincided with the holidays, yes? So, is this breakthrough depression or has my 60mg of Cymbalta, which I've been on for a year, pooped out?
In that year I've had bad days during which I've been able to recognize that they would pass and I'd be back at my passable, just almost motivated self. Had a few hypomanic episodes resulting in completed domestic projects and hysterical (thanks, Lar) arguments with spouse.
Now I'm at that self-loathing, sleeping too much, can't be bothered to bathe or dress mode. Getting in the car to get groceries is way too much trouble and cooking is a remote not quite possibility. Why bother. TV is not interesting. Books are not registering, the same page read over and over again. What is happening - my family or is a change of meds in my future?
Thanks for any thoughts.
p.s. anxiety is also bad at the moment. No panic attacks... yet.
Posted by Phillipa on January 2, 2006, at 21:53:31
In reply to Depression breakthrough vs poop-out, posted by ClearSkies on January 2, 2006, at 20:36:22
Clear Skies what is going on. I'm in the same boat sinking faster and faster. Just finished crying trying to figure out what is wrong with me and why my head feels like a basketball ready to burst. And I can't read a page of a book either. No concentration at all. Fondly, Phillipa
Posted by Racer on January 2, 2006, at 23:07:08
In reply to Depression breakthrough vs poop-out, posted by ClearSkies on January 2, 2006, at 20:36:22
I think that's got something to do with it in my case, grey days, wet, yucky.
But I've gotten back to the 'why bother?' stage myself, so badly my T asked if I should go to the hospital. I hadn't quite gotten that it was that bad.
Saw the new pdoc today, who upped the Wellbutrin and added Buspar. Cross your fingers for me.
She did say that Neurontin was showing up as a very good anxiolytic, for what that's worth...
Posted by Emily Elizabeth on January 2, 2006, at 23:10:59
In reply to Depression breakthrough vs poop-out, posted by ClearSkies on January 2, 2006, at 20:36:22
Hmmmm...I'm not sure, but I think the part about the holidays is key. Sort of a huge stressor that even the best of meds couldn't help, no? So I would vote breakthrough. I would hang in there for a bit more before switching away from a helpful med. Could you help the anxiety w/ an as-needed benzo? Or upping the cymbalta for a bit (I don't know much abt this particular med though, maybe that can't be done). I'd call pdoc and get some input. Maybe go in for your next appt sooner rather than later.
Hope things look sunny again soon!
Best,
EE
Posted by med_empowered on January 3, 2006, at 5:23:46
In reply to Re: Depression breakthrough vs poop-out, posted by Emily Elizabeth on January 2, 2006, at 23:10:59
hi! this sort of thing will happen. Personally, I'd avoid hospitalization unless you are suicidal. Hospitalization is usually better for jiggling meds and preventing self-harm than helping deal with the depression/mania/psychosis in and of itself.
Anyway, some docs go over the 60mgs/day cymbalta, which might help you..if it is poop out, upping the dose could restore efficacy. If its breakthrough depression, upping the dose could also help that. Adding an atypical antipsychotic--counterintuitive as that may seem, since you're already so withdrawn and lethargic--could help. If you went this route something like low-dose Abilify might help...at least with abilify if it doesn't work you probably won't gain weight or mess up your blood sugar any.
Are you on a mood stabilizer? Even if you're not bipolar, a mood stabilizer could help the antidepressant(s) work better and keep everything on a more-or-less even keel. Plus, some seem to have (modest) antidepressant effects, so that could be helfpul (lamictal could be a good option, since it seems to be so helpful for depression).
Stimulants help some people. Provigil would probably be a good first option, if your insurance will cover it; if not, Ritalin seems to help a lot of people as an add-on. The amphetamines are another option, but that's probably something that should wait for after trials of other stimulants.
Sometimes TCAs are helpful when added to other, newer antidepressants; since TCAs are tricky, especially in combo with other meds, this would probably be a combo done when other stuff fails. Personally, Tofranil PM (the newish once daily Tofranil) and Cymbalta helped alot for me. The big benefit was in **speed** of response; after a while, it kind of stabilized at low-grade depression, but the speed at which I was pulled out of hardcore misery was pretty impressive. The side effects really sucked though.
Posted by ClearSkies on January 3, 2006, at 6:53:50
In reply to Re: Depression breakthrough vs poop-out, posted by med_empowered on January 3, 2006, at 5:23:46
> Are you on a mood stabilizer? Even if you're not bipolar, a mood stabilizer could help the antidepressant(s) work better and keep everything on a more-or-less even keel. Plus, some seem to have (modest) antidepressant effects, so that could be helfpul (lamictal could be a good option, since it seems to be so helpful for depression).
I added lamictal this year - I'm stready at 150mg a day, and some Topamax for migraine, 50mg. They have topped off the upper edge of the mood swings and evened them out.
These dratted holidays, as much as I try to let them roll along without fuss and too much notice, really bother me on almost a cellular level. A lifetime of bad Christmases and drunken New Years are ingrained and hurtful patterns to escape. I really do think that I will go out of town and skip the whole family encounter and faux party atmosphere next year. Or else I could go pagan.
Posted by ghostshadow on January 3, 2006, at 21:08:05
In reply to Depression breakthrough vs poop-out, posted by ClearSkies on January 2, 2006, at 20:36:22
> I've been severely depressed for 10 days now. Funny how it coincided with the holidays, yes? So, is this breakthrough depression or has my 60mg of Cymbalta, which I've been on for a year, pooped out?
>
> In that year I've had bad days during which I've been able to recognize that they would pass and I'd be back at my passable, just almost motivated self. Had a few hypomanic episodes resulting in completed domestic projects and hysterical (thanks, Lar) arguments with spouse.
>
> Now I'm at that self-loathing, sleeping too much, can't be bothered to bathe or dress mode. Getting in the car to get groceries is way too much trouble and cooking is a remote not quite possibility. Why bother. TV is not interesting. Books are not registering, the same page read over and over again. What is happening - my family or is a change of meds in my future?
>
> Thanks for any thoughts.
> p.s. anxiety is also bad at the moment. No panic attacks... yet.except for the anxiety, this is how effexor made me feel. could be the holidays (this time of year is always bad for me, but much worse this year), could be the effeccts of your meds waning or a combination of both. hope this finds you feeling better.
((((hugs))))
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