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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 11 to 35 of 164. Go back in thread:
Posted by Nick on April 10, 1999, at 13:50:01
In reply to Re: Dysthymia/Treatment Resistant Depressions, posted by anne on April 9, 1999, at 22:24:58
> I'm a little confused about Nick's remarks lumping Effexor and Paxil into the neuroleptic category and would appreciate clarification here. I thought the action of neuroleptics was to decrease DA in the brain.
Sorry for the confusion! Effexor & paxil are not neuroleptics - nor is amisulpiride at low dose. I was simply tring to list a few drugs that have mood altering proerties and also an action on DA transmission. I should have mentioned amphetamines, which have powerful effects on DA release.
The difficulty with 'simple' i.e. one step theories like the monoamine hypothesis and also with our simplistic explanations of how the drugs work is that they often ignore the fact that if you do something to the brain - alter a transmitter release rate, for instance - it does something back - like modify receptor sensitivity. The theories also take no notice of the fact that monoamine systems talk not only to each other, but to other chemical systems, both between neurones and intraneuronally. I fear we are a long way from understanding it in any real way.
Posted by Jim on April 10, 1999, at 17:21:26
In reply to Re: Dysthymia/Treatment Resistant Depressions, posted by Wayne R. on April 10, 1999, at 8:07:41
Wayne--
While we're off in speculation-land, here's
my two cents on why naltrexone augmentation might
work for some people. Since naltrexone is an
opiate antagonist that can also help with drug and
alcohol cravings as well as impulse disorders
(gambling, cutting, etc.), I'd reckon that some
depressive states might also involve a counter-
productive "addiciton" to the body's own opiate
peptides. This addiction might be strong enough
to keep somebody chronically depressed by the way
the opiate system interacts with noradrenaline and
especially dopamine, among other things. Just my
personal hypothesis of course, awaiting
refutation!For the record, I recently tried adding very low
dose naltrexone to my Tofranil to see if I could
get your great results. Unforch, all I got were
some VERY unpleasant dreams before I threw in the
towel, perhaps prematurally...--Jim
Posted by Nancy on April 10, 1999, at 17:53:39
In reply to Re: Dysthymia/Treatment Resistant Depressions, posted by Elaine on April 9, 1999, at 23:16:52
> Typically, ADs do not work very well or very long for Bipolar disorder. I have been dx'd bipolar (NOS) but also have dysthymia. Do you know if this type of medication is supposed to be effective for depression in bipolars, particularly acute depressions?
??ACUTE/TREATMENT REFRACTIVE/DISABLING?? If it continues beyond 6months and you're suicidal, DON'T WAIT ANY LONGER!!! Get ECT done (it's 90% effective). Don't end up DOA at the ER like I did, then, on life support for days!
After the ECT, my 18 months of chronically suicidal, totally disabling, treatment resistive, absolutely intolerably painful/anguishing bipolar depression was stopped DEAD in ITS tracks (instead of ME being dead)!
Respectfully,
Nancy
Posted by Nancy on April 10, 1999, at 18:15:46
In reply to Re: Dysthymia/Bipolar Depression (Elaine), posted by Nick on April 10, 1999, at 13:37:54
However, Respiradone and Zyprexa didn't work for me (a severely bipolar 1, rapid cycler and treatment resistive). Recent augmentation of my treatments with T3 and T4 (to get the thyroid function into the upper-quartile range of "normal") have miraculously improved physiological responsiveness to AD and mood stabilizing meds.
> > I have been dx'd bipolar (NOS) but also have dysthymia. Do you know if this type of medication is supposed to be effective for depression in bipolars, particularly acute depressions?
>
> I don't know of anything yet BUT both risperidone and olanzapine have mood lifting properties and can also be useful for the treatment of mania/hypomania. However, they have a different mechanism of action to amisulpride (D2, D3 blocker, although potentiates DA transmission at low dose) Risperidone MAY be undergoing trials in bipolar disorder as a single therapeutic agent. I would have thought that amisulpiride might be a reasonable experiment, although at low dose with potentiation of DA transmission there is a risk (theoretically) of precipitating mania.
Posted by Nick on April 11, 1999, at 15:37:55
In reply to Re: Dysthymia/Bipolar Depression (Elaine), posted by Nancy on April 10, 1999, at 18:15:46
> Recent augmentation of my treatments with T3 and T4 (to get the thyroid function into the upper-quartile range of "normal") have miraculously improved physiological responsiveness to AD and mood stabilizing meds.
>Nancy - I'm delighted to hear thyroid augmentation was effective. It's a treatment that a lot of psychiatrists balk at. For my own education: how long did you have to wait for an effect, what doses of T3 and T4 were used, and did you get any side effects? I've had people complain of hair loss as well as sweats and diarrhoea. Thanks, Nick
Posted by Wayne R. on April 12, 1999, at 7:50:08
In reply to Re: Refractory depression--naltrexone theories?, posted by Jim on April 10, 1999, at 17:21:26
> Since naltrexone is an opiate antagonist that can also help with drug and alcohol cravings as well as impulse disorders (gambling, cutting, etc.), I'd reckon that some depressive states might also involve a counter-productive "addiciton" to the body's own opiate peptides. This addiction might be strong enough to keep somebody chronically depressed by the way the opiate system interacts with noradrenaline and especially dopamine, among other things…
Jim, I am just an interested patient and have no training in any of this. My question is why there would be no evidence of Naltrexone being an effective AD in its own right if this was the case? Everything I have seen points to it only being effective as an augmentation and even then only for the SSRI family. Wayne
Posted by Wayne R. on April 12, 1999, at 7:55:50
In reply to Re: Refractory depression--naltrexone theories?, posted by Jim on April 10, 1999, at 17:21:26
The onset of my depression is strongly linked to an Epstein-Barr infection. Does Epstein-Barr have known pathology in the systems that have been referred to? Could Epstein-Barr markers potentially be used to provide some measure as to whether a person might respond to SSRI with Naltrexone? Wayne
Posted by Wayne R. on April 12, 1999, at 8:00:51
In reply to Re: Refractory depression--naltrexone theories?, posted by Jim on April 10, 1999, at 17:21:26
> For the record, I recently tried adding very low dose naltrexone to my Tofranil to see if I could get your great results. Unforch, all I got were some VERY unpleasant dreams before I threw in the towel, perhaps prematurally...
I have been disheartened that I have not yet had postings or emails indicating a duplication of my results. In my last exchange with Dr Dante he indicated that he has had over 200 successes with Naltrexone. I sure wish there was a litmus test… Wayne
Posted by Elizabeth on April 12, 1999, at 8:38:39
In reply to Re: Dysthymia/Treatment Resistant Depressions, posted by Elaine on April 9, 1999, at 23:16:52
> Typically, ADs do not work very well or very long for Bipolar disorder. I have been dx'd bipolar (NOS) but also have dysthymia. Do you know if this type of medication is supposed to be effective for depression in bipolars, particularly acute depressions?
Elaine, I'm curious about this: what does the "NOS" mean in your case? I know it stands for "not otherwise specified," I mean why did you receive this diagnosis instead of bipolar I or II.
(I had a single mixed episode and recurring major depression, but my dx is bipolar NOS rather than bipolar I because it wasn't clear whether the mixed episode was spontaneous, or whether it was an idiosyncratic reaction to an antidepressant. My assumption has been the latter.)
Posted by Elizabeth on April 12, 1999, at 9:11:33
In reply to Re: Bipolar/Treatment Resistant Depressions/ECT!!!, posted by Nancy on April 10, 1999, at 17:53:39
Nancy,
I agree that ECT is a good choice in some emergencies, but I also seem to recall that some subtypes of depression don't respond well to it. Anyone know anything about this? (My recollection is that it was more effective in severe or delusional depression and less effective (or ineffective) in dysthymic or atypical depression.)
I'd actually say that for resistant dysthymia, if there's a need for immediate results (which wasn't the impression I got from Elaine's post...Elaine, could you elaborate?), amphetamines (e.g., methylphenidate or d-amphetamine) might be a good thing to try, as they tend to work fast (when they do work).
For long-term treatment of bipolar depression, the atypical antipsychotics are worth a try, as they seem to act as antidepressants in some people. (Not everybody, though.)
Posted by Nancy on April 12, 1999, at 16:40:45
In reply to Re: Dysthymia/Bipolar Depression (Elaine), posted by Nick on April 11, 1999, at 15:37:55
> > Recent augmentation of my treatments with T3 and T4 (to get the thyroid function into the upper-quartile range of "normal") have miraculously improved physiological responsiveness to AD and mood stabilizing meds.
> >
>
> Nancy - I'm delighted to hear thyroid augmentation was effective. It's a treatment that a lot of psychiatrists balk at.***NO KIDDING!!! I went through hell and high water to get T-three and T4!!!!!!!!!!! In just the first 7 days of taking T-three, you will begin to feel more energetic. ??i have to spell out the word "three" because my keyboard just lost it's mind...the numeral three isn't working at the moment(33333...see?)...oh, well.
Anyway, (oh, i love to tell my stories....Thank You!) my pdoc and gp were totally against using thyroid augmentation BECAUSE MY TEST RESULT CAME BACK "NORMAL". I finally began asking where on the range of "normal" was I???? GET THIS: Doctors say that your thyroid levels are normal, even when those levels are in the "low end of normal". Which, by the way, IS NOT sufficient thyroid level for treatment refractory patients!
The pdoc who had read literature (even after graduating from med school) important for prescribing drugs for severly treatment resistive bipolar patients (like me), was the pdoc who ended my 18 months of agonizing and totally disabling depression.
:) ok next question (deep breath)
For my own education: how long did you have to wait for an effect, what doses of T3 and T4 were used, and did you get any side effects?****Dosage begins at 0.05mgs/ A.M./ empty stomach. An ultra sensitive thyroid blood test is done two weeks later. Increase dosage by 0.05mgs, as before, until both T3three and T4 levels are in the upper-quartile of the "normal" range.
Personally??? the doses of thyroid meds I take...T4 = 0.15mgs and T3three = 0.05mgs...at the present time
Side Efeects??? be careful that you don't drink enough caffienated drinks to cause a pounding heart...you may have some flushing (turning a little pinkish) of your skin, rather than the pale sickly color of the skin when your thyroid is "low normal"...oh, also, you may feel a lot better than you ever have since this awful depression began!
I've had people complain of hair loss as well as sweats and diarrhoea. Thanks, NickOh yea, the thyroid meds will make you feel warmer. Which is a great benefit to those of us who always felt cold all the time. Haven't noticed hair loss. But, I have very long, curly blonde hair. It would probably take a long time for me to notice much of my hair missing...hee hee hee :) Nancy
Posted by Danielle on April 12, 1999, at 17:37:10
In reply to Re: Dysthymia/Bipolar Depression (Elaine), posted by Nancy on April 12, 1999, at 16:40:45
> > > Recent augmentation of my treatments with T3 and T4 (to get the thyroid function into the upper-quartile range of "normal") have miraculously improved physiological responsiveness to AD and mood stabilizing meds.
> > >
> >
> > Nancy - I'm delighted to hear thyroid augmentation was effective. It's a treatment that a lot of psychiatrists balk at.
>
> ***NO KIDDING!!! I went through hell and high water to get T-three and T4!!!!!!!!!!! In just the first 7 days of taking T-three, you will begin to feel more energetic. ??i have to spell out the word "three" because my keyboard just lost it's mind...the numeral three isn't working at the moment(33333...see?)...oh, well.
>
> Anyway, (oh, i love to tell my stories....Thank You!) my pdoc and gp were totally against using thyroid augmentation BECAUSE MY TEST RESULT CAME BACK "NORMAL". I finally began asking where on the range of "normal" was I???? GET THIS: Doctors say that your thyroid levels are normal, even when those levels are in the "low end of normal". Which, by the way, IS NOT sufficient thyroid level for treatment refractory patients!
>
> The pdoc who had read literature (even after graduating from med school) important for prescribing drugs for severly treatment resistive bipolar patients (like me), was the pdoc who ended my 18 months of agonizing and totally disabling depression.
> :) ok next question (deep breath)
>
>
> For my own education: how long did you have to wait for an effect, what doses of T3 and T4 were used, and did you get any side effects?
>
> ****Dosage begins at 0.05mgs/ A.M./ empty stomach. An ultra sensitive thyroid blood test is done two weeks later. Increase dosage by 0.05mgs, as before, until both T3three and T4 levels are in the upper-quartile of the "normal" range.
>
> Personally??? the doses of thyroid meds I take...T4 = 0.15mgs and T3three = 0.05mgs...at the present time
>
> Side Efeects??? be careful that you don't drink enough caffienated drinks to cause a pounding heart...you may have some flushing (turning a little pinkish) of your skin, rather than the pale sickly color of the skin when your thyroid is "low normal"...oh, also, you may feel a lot better than you ever have since this awful depression began!
>
>
>
> I've had people complain of hair loss as well as sweats and diarrhoea. Thanks, Nick
>
> Oh yea, the thyroid meds will make you feel warmer. Which is a great benefit to those of us who always felt cold all the time. Haven't noticed hair loss. But, I have very long, curly blonde hair. It would probably take a long time for me to notice much of my hair missing...hee hee hee :) NancyHi Nancy:
Same for me, only I was also losing big globs of hair. Finally got hold of a endocrinologist - ob/gyn who said the others were silly, low end of normal wasn't normal for me! Ranges aren't absolutes.
Danielle
Posted by Jim on April 12, 1999, at 19:02:34
In reply to Re: Refractory depression--naltrexone theories?, posted by Wayne R. on April 12, 1999, at 8:00:51
Wayne,
On your questions about who naltrexone
works for and why, I too am just an
interested (perhaps too interested!)
patient. I agree that most reports
(especially Lee Dante's) see it working
only as an augmentation strategy with
things like SSRIs (and also sometimes
tricyclics). But when I did some of my own
research on naltrexone use across
the board, I did find a bunch of places
in the alcholism & autism literature where
there was some question about whether it
might have an antidepressant effect in its
own right. This has not really been
formally researched so you're right to see
naltrexone as remaining basically an
augmentation strategy for the time being.
(My *theory* that I posted was basically
the best one that I as a non-specialist could
come up with!) If there are other people
that naltrexone has helped, I'd be interested
to see them come out of the woodwork too!
-Jim
Posted by Elaine on April 12, 1999, at 21:53:30
In reply to bipolar NOS - Elaine, posted by Elizabeth on April 12, 1999, at 8:38:39
It's the same thing - Not Otherwise Specified. Since not everything fits a clean diagnosis, they always have to leave an 'out'. In my case, I don't have mania, per se; my psychiatrist feels that the anger flashes I sometimes get fits into a bipolar dx, particular since, again, AD's haven't helped my bouts of depression as well as should. Since she tried several over the years and one characteristic of bipolar is not responding well or for very long to AD's...
I'm still not entirely convinced about the bipolar dx, but it's just a name as long as she knows what meds are helping. Again, though, I do not suffer from mania (although it might be nice just once, just for a little while?), so it really throws me into a strange category. I believe there is research about bipolar of a more dysthymic nature.
Is this anything you were looking for?
Posted by Elaine on April 12, 1999, at 22:02:04
In reply to Re: Dysthymia/Bipolar Depression (Elaine), posted by Nancy on April 12, 1999, at 16:40:45
My pdoc DID prescribe thyroid augmentation even though the doc's lab tests came back "Normal". She told me that a psych's range of "normal" can be different from a gp. I don't always know what helps, but she says it has. I guess I should consider myself fortunate that she doesn't simply go with the standard results.
Excuse me, did someone say "be careful you don't drink enough caffienated drinks"? I assume you mean "too much"? Does that apply to all thyroid meds? It seems I wake up sometimes with a pounding heart - (no, NOT anxiety or nightmares) - how long can the combination take before the side effect shows up? I never really thought about side effects with thyroid meds.
Posted by Elizabeth on April 13, 1999, at 1:40:28
In reply to Re: bipolar NOS - Elizabeth, posted by Elaine on April 12, 1999, at 21:53:30
Hi Elaine. Yup, that's the answer I was interested in. :-)
A diagnosis of bipolar without anything resembling manic or hypomanic episodes seems a bit odd to say the least. There is such a thing as dysphoric mania or hypomania, in which a person feels very irritable rather than euphoric. That doesn't sound like what you're describing, though.
I seem to recall reading an article somewhere or other about depression (unipolar) with "anger attacks" (similar to panic attacks, with the same kind of autonomic symptoms).
I've also heard of cases in which "rages" turned out to be complex partial seizures and were successfully treated with AEDs.
What sort of meds are you using, and are you having any luck?
Posted by Andrew on April 13, 1999, at 16:12:03
In reply to Dysthymia/Treatment Resistant Depressions, posted by JohnB. on April 8, 1999, at 23:24:43
It would be interesting to hear the personal experiences of those using Amisulpride to treat their dysthymia.
I've taken Amineptine for dysthymia, a general dopamine reuptake blocker, at a small dose for about 3 months with good results. I've had for as long as I can remember low mood and lack of drive. I had tried both Serzone and Buproprion (Wellbutrin). Neither medicine improved my mood however. The Amineptine gently provides me with drive. It is as if it helps provide the energy that allows me to care about and enjoy life. That has been my experience anyway.
Amineptine has had the minor side effect (at 50 mg./day) of making patterns 'dance' sometimes before my eyes, such as the pattern on a carpet in a dark hallway. When I had tried it at a higher dose it made the colors of some objects glow. Also, my thoughts became scattered and I felt irritable. So I don't take a higher dose.
I wonder if Amisulpride, since it targets only the D2-D3 receptors, has less of these side effects?
I've read Pramipexole, used to treat Parkinsons, has been shown in early trials to be effective for depression. It is described as either a D3 agonist or a D2-D3 agonist. Does anyone have experience with this medicine?
Posted by Nancy on April 13, 1999, at 16:57:45
In reply to Re: Dysthymia/Bipolar Depression (Elaine), posted by Danielle on April 12, 1999, at 17:37:10
Hi Danielle,
It's wonderful to hear that your are recieving proper treatment. It's terrible to look to a physician for help, but find ignorance instead.
:) Nancy
> > > > Recent augmentation of my treatments with T3 and T4 (to get the thyroid function into the upper-quartile range of "normal") have miraculously improved physiological responsiveness to AD and mood stabilizing meds.
> > > >
> > >
> > > Nancy - I'm delighted to hear thyroid augmentation was effective. It's a treatment that a lot of psychiatrists balk at.
> >
> > ***NO KIDDING!!! I went through hell and high water to get T-three and T4!!!!!!!!!!! In just the first 7 days of taking T-three, you will begin to feel more energetic. ??i have to spell out the word "three" because my keyboard just lost it's mind...the numeral three isn't working at the moment(33333...see?)...oh, well.
> >
> > Anyway, (oh, i love to tell my stories....Thank You!) my pdoc and gp were totally against using thyroid augmentation BECAUSE MY TEST RESULT CAME BACK "NORMAL". I finally began asking where on the range of "normal" was I???? GET THIS: Doctors say that your thyroid levels are normal, even when those levels are in the "low end of normal". Which, by the way, IS NOT sufficient thyroid level for treatment refractory patients!
> >
> > The pdoc who had read literature (even after graduating from med school) important for prescribing drugs for severly treatment resistive bipolar patients (like me), was the pdoc who ended my 18 months of agonizing and totally disabling depression.
> > :) ok next question (deep breath)
> >
> >
> > For my own education: how long did you have to wait for an effect, what doses of T3 and T4 were used, and did you get any side effects?
> >
> > ****Dosage begins at 0.05mgs/ A.M./ empty stomach. An ultra sensitive thyroid blood test is done two weeks later. Increase dosage by 0.05mgs, as before, until both T3three and T4 levels are in the upper-quartile of the "normal" range.
> >
> > Personally??? the doses of thyroid meds I take...T4 = 0.15mgs and T3three = 0.05mgs...at the present time
> >
> > Side Efeects??? be careful that you don't drink enough caffienated drinks to cause a pounding heart...you may have some flushing (turning a little pinkish) of your skin, rather than the pale sickly color of the skin when your thyroid is "low normal"...oh, also, you may feel a lot better than you ever have since this awful depression began!
> >
> >
> >
> > I've had people complain of hair loss as well as sweats and diarrhoea. Thanks, Nick
> >
> > Oh yea, the thyroid meds will make you feel warmer. Which is a great benefit to those of us who always felt cold all the time. Haven't noticed hair loss. But, I have very long, curly blonde hair. It would probably take a long time for me to notice much of my hair missing...hee hee hee :) Nancy
>
> Hi Nancy:
> Same for me, only I was also losing big globs of hair. Finally got hold of a endocrinologist - ob/gyn who said the others were silly, low end of normal wasn't normal for me! Ranges aren't absolutes.
> Danielle
Posted by Nancy on April 13, 1999, at 17:03:53
In reply to Re: Bipolar/Treatment Resistant Depressions/ECT!!!, posted by Elizabeth on April 12, 1999, at 9:11:33
> Nancy,
>
> I agree that ECT is a good choice in some emergencies, but I also seem to recall that some subtypes of depression don't respond well to it. Anyone know anything about this? (My recollection is that it was more effective in severe or delusional depression and less effective (or ineffective) in dysthymic or atypical depression.)
>
> I'd actually say that for resistant dysthymia, if there's a need for immediate results (which wasn't the impression I got from Elaine's post...Elaine, could you elaborate?), amphetamines (e.g., methylphenidate or d-amphetamine) might be a good thing to try, as they tend to work fast (when they do work).
>
> For long-term treatment of bipolar depression, the atypical antipsychotics are worth a try, as they seem to act as antidepressants in some people. (Not everybody, though.)Gee, ever hear of dyskinesia???? As far as ECT goes, it was the ONLY treatment that stopped my 18 month dibilitating bipolar depression. I should have had ECT after 6 months of treatment resistance.
You need to go back and read some of my posts and do some more research regarding this kind of illness.
Good Luck,
Nancy
Posted by Elaine on April 14, 1999, at 0:19:40
In reply to Re: bipolar NOS - Elaine, posted by Elizabeth on April 13, 1999, at 1:40:28
Hi, Elizabeth! The unipolar depression with "anger attacks" sounds interesting, although I'm not quite sure what an "anger attack" would be. I think possibly not. I will just sometimes have such a reaction to something that I have to do or say SOMETHING to release the tension. Nothing too drastic, though. It's just like jumping over an imaginary line, even when I shouldn't be feeling too much under attack or defensive. Anyway, I am on lithium, levoxyl (to boost thyroid, rx'd by pdoc) and, since December, gabapentin (Neurontin), due to a possible start of a depression. It's always hard to tell what helps a condition, or whether time has helped, but I haven't had a sudden, intense reaction in quite awhile, so possibly the meds have gradually helped. I am more prone to depression than the anger, as you might be able to tell from the meds, but it is nice not to feel I may jeopardize a job or something by an inappropriate reaction. Again, it is not like a rage or anything that severe, just an intense reaction where I almost feel removed from myself and I need to do or say SOMETHING to release the tension. I don't know if this makes sense at all...
How are you doing and have you found others who you can relate to, even though you are in the infamous "NOS" category?
Posted by Steve on April 14, 1999, at 3:29:09
In reply to Re: Refractory depression--naltrexone theories?, posted by Jim on April 12, 1999, at 19:02:34
The brain cleaves its opiates out of one big
peptide called ACTH, which is undersecreted in
some forms of depression. It is conceivable that
by blocking the mu opiate receptor you can trick
the brain into churning out more ACTH, and therefore
more opiates which do elevate mood.> Wayne,
> On your questions about who naltrexone
> works for and why, I too am just an
> interested (perhaps too interested!)
> patient. I agree that most reports
> (especially Lee Dante's) see it working
> only as an augmentation strategy with
> things like SSRIs (and also sometimes
> tricyclics). But when I did some of my own
> research on naltrexone use across
> the board, I did find a bunch of places
> in the alcholism & autism literature where
> there was some question about whether it
> might have an antidepressant effect in its
> own right. This has not really been
> formally researched so you're right to see
> naltrexone as remaining basically an
> augmentation strategy for the time being.
> (My *theory* that I posted was basically
> the best one that I as a non-specialist could
> come up with!) If there are other people
> that naltrexone has helped, I'd be interested
> to see them come out of the woodwork too!
> -Jim
Posted by Elizabeth on April 14, 1999, at 6:31:41
In reply to Re: Bipolar/Treatment Resistant Depressions/ECT!!!, posted by Nancy on April 13, 1999, at 17:03:53
> Gee, ever hear of dyskinesia???? As far as ECT goes, it was the ONLY treatment that stopped my 18 month dibilitating bipolar depression. I should have had ECT after 6 months of treatment resistance.
EPS don't occur at lower doses of the atypical antipsychotics (olanzapine probably better than risperidone). (Low doses are usually sufficient for nonpsychotic affective illness, as far as I can tell.)
I do read your posts and I'm sure that ECT was right for *you*, but I think you should be a little more conservative in recommending it to other people regardless of the form their illness takes. It's appropriate in some cases of very severe or refractory depression (or mania), but not for more minor affective illness, such as dysthymic depression. And as noted, it may not even work in some types of depression. It's an extreme measure, necessary in some cases but not a first-line treatment.
Posted by Jim on April 14, 1999, at 7:37:18
In reply to Re: Refractory depression--naltrexone theories?, posted by Steve on April 14, 1999, at 3:29:09
Steve wrote:
> The brain cleaves its opiates out of one big
> peptide called ACTH, which is undersecreted in
> some forms of depression. It is conceivable that
> by blocking the mu opiate receptor you can trick
> the brain into churning out more ACTH, and therefore
> more opiates which do elevate mood.
>
>
Steve--
Actually, my unschooled hypothesis is somewhat different, though you're probably right to a certain extent. From what I've seen, however, most clinical efficacy of naltrexone seems to come from the opiate antagonism itself--one of the best supported examples of this might be in self-cutting patients, who are probably literally "addicted" to the endogenous opiates (endorphins) they can produce by hurting themselves. The same could be said for binge-eating and compulsive gambling patients, who have also apparently shown some good responses to naltrexone treatment. I suppose my underlying hypothesis here is that certain types of depression may have similar processes at work, even if they are not manifested in outright behaviors. (Opioids are produced in response to stress, and stress is both a causal factor and a feature of depression...) Naltrexone may help to extinguish these kinds of psychological / physiological" short circuits" that, like morphine addiction, flood the system with opiates and thereby downregulate (i.e., decrease the number of) the opoid receptors. A good part of naltrexone's efficacy may come from its ability, through antagonism, to help restore the receptor population to normal levels so that opioids can function more "normally" in the body once again, perhaps in some cases even at *lower* levels than before treatment. (The research I've seen is very inconclusive about what naltrexone does to endorphin blood levels.) Once again, all my spoutings here to be taken with a healthy adjunctive grain of salt, since they are basically those of an armchair neuropharmacologist!
Best,
Jim
Posted by Elizabeth on April 14, 1999, at 17:51:11
In reply to Re: bipolar NOS - Elizabeth, posted by Elaine on April 14, 1999, at 0:19:40
Hi Elaine.
I figured out where I heard about "anger attacks" in depression: some people at Mass. General have been researching the connection between anger attacks, depression, panic disorder, etc. for about a decade. The site listing current research is www.hmcnet.harvard.edu/psych/redbook.
Anyway, anger attacks are linked mainly with unipolar depression - not manic-depression or (despite some obvious similarities) panic disorder. You didn't mention whether you experience symptoms of autonomic arousal (rapid heartbeat or palpitations, sweating, nausea, difficulty breathing, etc.) during your "spells," but that's what distinguishes "anger attacks."
Anyway, irritability can occur in depression as well as mania. (I think it's only recognized "officially" in childhood depression, but there's no reason to suppose that adults couldn't show irritability as a symptom of depression too. Especially since, well, they do.)
I'm sort of startled by the idea that if you are depressed but don't seem to respond to antidepressants, you must be bipolar (even if you've never had a manic episode). Which antidepressants have you tried, and how is your current cocktail working out? (I'd never heard of Neurontin being used for depression as such, although I have seen its increasing popularity for use in anxiety disorders.) The name doesn't matter too much, as its main purpose is to communicate with other clinicians about you (e.g., if you're hospitalized, or if you move and need to get a new psychiatrist). (Well, that and to communicate with your insurance co. :-P) But given what you've said, "bipolar" seems like a misleading description.
I know of a number of people who, like me, seem to have "bipolar III" - informally, this designation is sometimes used to describe a syndrome of recurring major depression with one of: (1) antidepressant-induced manic or hypomanic symptoms; (2) family history of bipolar disorder; or (3) "hypomanic temperament." I think most people who develop mania or hypomania on antidepressants have milder symptoms than I did (I had a minor episode on Paxil and a severe mixed episode (psychotic) on Effexor). My depressions are pretty "classic," though.
Buprenorphine works pretty well for me, but it has a lot of side effects so I'm not sure I'd recommend it unless you've exhausted most of your other options.
Posted by Elizabeth on April 14, 1999, at 18:01:47
In reply to Re: Refractory depression--naltrexone theories?, posted by Jim on April 14, 1999, at 7:37:18
> Actually, my unschooled hypothesis is somewhat different, though you're probably right to a certain extent. From what I've seen, however, most clinical efficacy of naltrexone seems to come from the opiate antagonism itself--one of the best supported examples of this might be in self-cutting patients, who are probably literally "addicted" to the endogenous opiates (endorphins) they can produce by hurting themselves.
This jumped out at me because, from having talked to "cutters," I really do get the impression that cutting is addictive for them, that they have "urges" the same way that a substance addict has "cravings." (Maybe other forms of self-injury can be addictive as well, but it's curious how people seem to discover cutting independently *so* often)
A researcher I've spoken to who has some experience using opioids of various sorts for depression says that naltrexone by itself often causes dysphoria. It might be that naltrexone works specifically in the type of cases you list (impulse-control type disorders). (I won't presume to guess why it would cause relief sometimes and dysphoria other times, since I imagine I'd just be proved wrong. :-})
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