Posted by Racer on September 20, 2000, at 13:55:19
In reply to Newbie w/treat-res melancholic double depression, posted by MarkinBoston on September 19, 2000, at 3:59:56
This may sound nuts, but then, that's why I'm on meds, right? ;-)
Have you talked to your doctor about treating the cortisol/dex part separately? Yeah, nuts... I don't mean this as belittling your trouble, but my horse also suffers from raised cortisol, etc: it's a whole disease for her, Cushing's syndrome. The symptoms are different, since you're a human in the prime of life and she's an elderly equine, but the depression, weight changes, hormones, etc, are similar.
Treatments for Cushing's in horses are very limited, and expensive since they're based on human drugs at veterinary doses, but the drugs of choice are:
Periactin (cyproheptidine), which is an older anti-histimine, and can fix sleeplessness (though you'll be groggy the next morning) and temporarily fixes the anorgasmia from SSRIs. It's available generically, so the cost is negligible. The trouble, of course, is that it's also used to promote appetite...
Pergolide is a parkinson's drug, which has been shown to be very effective against Cushings. I used to know the thinking behind it, but I've got the icks today, and can hardly remember my own name (thanks Dr Bob for the forms knowing it for me, eh?), so I can't help there...
None of that is to say that I know anything much at all, just a suggestion for you. It sounds as though you've been through the wringer, so maybe this will help you and your doctor come up with a new idea which will maybe help.
A couple more thoughts, for what they're worth:
Have you had your thyroid tested?
Have you tried non-drug treatments for the SAD portion of your depression? Light, exercise, shaking your fist at the rain clouds? Can't hurt, right?
Have you had the cortisol tests done while you were NOT experiencing a depressive episode? I know, I know, but I'm back to my horse again. I know that she will go through periods when she gets sicker or more depressed, or just turns into the nasty-bitch-mare-from-hell for a few days. I wonder if you're suffering something like what she has?
Cushings in horses, by the way, (and dogs) is caused by a benign tumor on the pituitary gland which interupts the normal functioning of the feedback loop with the adrenal glands to produce cortisol and so on. Has anyone checked you for something similar? I know that the dex-sup test is used to diagnose it in horses...
Poor Mark, I know what hell it is to look for help without finding it, sure made me feel as though life wasn't worth living last time around (old timers on this board will remember and tell you about that!) I do hope you find relief soon.
Oh, and I'm leaning near to stjames: while I won't tell you to stay on ADs forever, I will suggest that you stay on them long enough to reset your chemistry. I've read that for recurrent depression, you should plan on staying on the drugs for 2 calendar years past the point they finally work. Same article said that going on and off a lot could make the drugs LESS effective over time. How long have you been staying on them?
Good luck.
poster:Racer
thread:44895
URL: http://www.dr-bob.org/babble/20000905/msgs/44969.html