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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by JahL on January 12, 2001, at 13:51:49
I know there's plenty in the archives about Depakote but the Search is down...
Anyway after trying almost every drug conceivable, my new pdoc has stuck me on Depakote (750+mg/day for 1 month+) for TR dysthymia (+double depression, social phobia, depersonalisation)
What I'd like to know is, has anyone successfully treated UNIpolar depression with this stuff (alone)?
I am particularly concerned with treating anhedonia/cognitive dysfunction.Any experiences/comments appreciated.
Ta,
Jah.
Posted by phillybob on January 12, 2001, at 21:19:11
In reply to Re: Depakote for dysthymia(SOURCES 4?)?, posted by JahL on January 12, 2001, at 18:16:35
Hey, JahL, check this discussion thread out. I put an article in one of the posts about a doctor who has had such success: http://www.dr-bob.org/babble/20001231/msgs/50878.html
Also, I think you too have had some experience with topamax, too? I forget. Is that what anhedonia means? :) (blasted non-functioning search function ... metaphorically-speaking ... ?)
Posted by JohnL on January 13, 2001, at 4:25:15
In reply to Depakote for dysthymia?, posted by JahL on January 12, 2001, at 13:51:49
I don't think Depakote will help much for anhedonia. I mean, anything's possible actually, but in my anhedonia battles and studies I've found the most probable help is in the medication classes of antipsychotics, stimulants, and tricyclic antidepressants.
Mood stabilizers and SSRIs will often make anhedonia worse, or have no effect. They tend to numb emotions and smooth out the electrical/chemical processes in the brain. This is the opposite of what you need. I think the first step to getting well is to consider that anhedonia is often times a completely separate beast from depression. Though it is a core symptom of depression, it can also be a condition all its own. Antidepressants are generally not very helpful. You need stimulation, not smoothing.
After trying literally dozens of drugs to treat my anhedonia (just about any drug you can name), I ended up finding the most help in a antipsychotic+stimulant combination, with a little Prozac in the background. I think the reason they work so well is because they target dopamine and noradrenaline, which are the chemistries most likely responisble for anhedonia. Anhedonia is often a result of hypo-dopamine function and/or hypo-NE function.
In the antipsychotic class you could try low dose Zyprexa or Risperdal, preferably both one at a time for comparison. Four weeks each should be enough to determine effectiveness. Actually if they are going to work, you should have a hint of that anywhere from one week to three. My favorite drug in this class though is a European antipsychotic called Amisulpride. It is superior to American antipsychotics by a long shot, in my opinion.
In the stimulant class you could try Ritalin and Adderall. One week each should be enough to determine if they will be helpful. My favorite in this class is Adrafinil, a European stimulant. It is quite unique in its ability to increase motivation and interest without the physical stimulation common to other stimulants.
I guess you could try Depakote if you want to, but personally I think the odds of it being helpful are very low. If you want the best odds in your favor, stick to antipsychotics and stimulants. Or even better, both combined. And of course TCAs like Desipramine or Nortriptyline can work, but their side effects are usually a bit much for most people. If I had to take one shot at getting you well, and there was only one chance to do it, I would place all my bets on Amisulpride+Adrafinil. In the event that you do not want to enter the arena of self-directed care and mailordering your own meds, then definitely explore the antipsychotic+stimulant categories available through your doctor.
After all is said and done, I could be wrong. Who knows, Depakote could be a miracle. But it's a game of statistics and educated guesses. With that in mind, I think antipsychotics and stimulants by far have the highest odds for success.
John
Posted by JahL on January 13, 2001, at 7:21:42
In reply to Re: Depakote for dysthymia(SOURCES 4?)?, posted by phillybob on January 12, 2001, at 21:19:11
> Also, I think you too have had some experience with topamax, too? I forget.Hi Bob.
No. But I've been following yr Topamax threads with great interest. Next on the list perhaps?!>Is that what anhedonia means? :) (blasted non-functioning search function ... metaphorically-speaking ... ?)
Anhedonia = (unfortunately) inability to experience pleasure.
Ta, Jah.
Posted by phillybob on January 13, 2001, at 9:39:47
In reply to Depakote for dysthymia?, posted by JahL on January 12, 2001, at 13:51:49
John, I find your following breakdown very interesting: "Anhedonia is often times a completely separate beast from depression. Though it is a core symptom of depression, it can also be a condition all its own."
What would you consider your diagnosis? Have you found long-term success or soley temporary respite with the particular meds that you have suggested for the anhedonia alone or other complementary diagnosis as well? I believe much of this information would be helpful in trying to evaluate next steps for us all. (Now that I've been apprised of what anhedonia is, thanks Jah, I now know the technical jargon for one of my symptoms).
Jah, with the way John had beautifully dissected anhedonia from double depression, etc., I guess, you'd kind of have to figure out whether you'd like to try and attack them both at once, or one at a time or one and then the other? My mood stabilizer trial as monotherapy is an attempt for an even keel (balancing the double depression/dysthymic type symptoms). Hopefully, eventually, I'll be able to partake in pleasure again ... I know thus far, things are less stressful due to them be less depressing and less stable which in some ways is, in fact, more enjoyable.
Posted by JahL on January 13, 2001, at 10:49:15
In reply to Re: Depakote for dysthymia?, posted by JohnL on January 13, 2001, at 4:25:15
> I don't think Depakote will help much for anhedonia. I mean, anything's possible actually, but in my anhedonia battles and studies I've found the most probable help is in the medication classes of antipsychotics, stimulants, and tricyclic antidepressants.
>
> Mood stabilizers and SSRIs will often make anhedonia worse, or have no effect. They tend to numb emotions and smooth out the electrical/chemical processes in the brain. This is the opposite of what you need. I think the first step to getting well is to consider that anhedonia is often times a completely separate beast from depression. Though it is a core symptom of depression, it can also be a condition all its own. Antidepressants are generally not very helpful. You need stimulation, not smoothing.
>
> After trying literally dozens of drugs to treat my anhedonia (just about any drug you can name), I ended up finding the most help in a antipsychotic+stimulant combination, with a little Prozac in the background. I think the reason they work so well is because they target dopamine and noradrenaline, which are the chemistries most likely responisble for anhedonia. Anhedonia is often a result of hypo-dopamine function and/or hypo-NE function.
>
> In the antipsychotic class you could try low dose Zyprexa or Risperdal, preferably both one at a time for comparison. Four weeks each should be enough to determine effectiveness. Actually if they are going to work, you should have a hint of that anywhere from one week to three. My favorite drug in this class though is a European antipsychotic called Amisulpride. It is superior to American antipsychotics by a long shot, in my opinion.
>
> In the stimulant class you could try Ritalin and Adderall. One week each should be enough to determine if they will be helpful. My favorite in this class is Adrafinil, a European stimulant. It is quite unique in its ability to increase motivation and interest without the physical stimulation common to other stimulants.
>
> I guess you could try Depakote if you want to, but personally I think the odds of it being helpful are very low. If you want the best odds in your favor, stick to antipsychotics and stimulants. Or even better, both combined. And of course TCAs like Desipramine or Nortriptyline can work, but their side effects are usually a bit much for most people. If I had to take one shot at getting you well, and there was only one chance to do it, I would place all my bets on Amisulpride+Adrafinil.AND YOU WOULD BE OUT OF POCKET, MATE! (see below)
> In the event that you do not want to enter the arena of self-directed care < I AM AS SELF-DIRECTING AS THEY COME! > and mailordering your own meds, then definitely explore the antipsychotic+stimulant categories available through your doctor.
>
> After all is said and done, I could be wrong. Who knows, Depakote could be a miracle. But it's a game of statistics and educated guesses. With that in mind, I think antipsychotics and stimulants by far have the highest odds for success.
> JohnHi John. Thanks for yr advice. In fact I have tried ALL the drugs you mention (& many more besides), save for Desip. & Nortrip. (but have taken in place of these v. high dose Clomipramine, Imipramine, Trimipramine & Reboxetine.)
The only drug to offer any consistent (albeit modest) benefit is Sulpiride (& then only w/ social phobia).
The only time I have felt free from anhedonia was during a brief (& total) SSRI-induced remission (which suggests my anhedonia IS related to my other symptoms).
I must agree I share yr pessimism for Depakote, which is why (w/o pdoc's knowledge) I am conducting a concurrent 50 day trial of low-dose Liquid Deprenyl Citrate (checked 4 drug-drug interactions), as proposed by AndrewB.
I am currently taking DEPAKENE (Valproic Acid) & whilst I no longer feel acutely suicidal, I agree that the overall sensation is a 'numbing' one.
Funnily enough, Depakote was actually recommended to me by a pdoc I know you personally hold in v. high regard(!?!!)
As you say, there's no telling in this game!
Thanks again,
Jah.
Posted by JahL on January 13, 2001, at 11:30:14
In reply to Re: Depakote for dysthymia?, posted by phillybob on January 13, 2001, at 9:39:47
> Jah, with the way John had beautifully dissected anhedonia from double depression, etc., I guess, you'd kind of have to figure out whether you'd like to try and attack them both at once, or one at a time or one and then the other?> My mood stabilizer trial as monotherapy is an attempt for an even keel (balancing the double depression/dysthymic type symptoms).
> Hopefully, eventually, I'll be able to partake in pleasure again ... I know thus far, things are less stressful due to them be less depressing and less stable which in some ways is, in fact, more enjoyable.
Hi Bob.
Know what you mean there but things still aren't PLEASURABLE, are they? (The Depakene I'm on is similarly taking the edge off my depression.)When I gained complete (but brief) remission on a coupla' SSRIs, ALL my symptoms remitted simultaneously, which suggests they ALL have a common origin. *Theoretically* therefore a single (correct) drug *shld* be able to fix things. This doesn't rule out polypharmacy, but suggests all drugs would be working towards a common goal. Does this answer yr 1st Q?
A more direct answer is; I'm aiming for nothing less than a full (speedy!) remission of my condition (ie every symptom, collectively-the SSRIs proved it's possible).
Hoping you get the same,
Jah.
Posted by judy1 on January 13, 2001, at 15:14:38
In reply to Depakote for dysthymia?, posted by JahL on January 12, 2001, at 13:51:49
Hi Jah,
First I think depakote is the most depressing drug available- sure works for mania though. I apologize for not going through all your replies, but have you tried lamictal yet? I'm only on 50mg right now, but I can feel my dissociation improving and you mentioned a problem with that. I did become manic in the past at 100mg, but that could have been me cycling- and I wouldn't mind some of that now. Take care, Judy
Posted by JahL on January 13, 2001, at 18:04:35
In reply to Re: Depakote for dysthymia? » JahL, posted by judy1 on January 13, 2001, at 15:14:38
>have you tried lamictal yet? I'm only on 50mg right now, but I can feel my dissociation improving and you mentioned a problem with that. Take care, Judy
Hi Judy.
No I haven't tried Lamictal yet, but the depersonalisation bit sounds promising! The impression I'm getting from this & other sites is that Lamictal may possess unique AD properties amongst the anti-convulsants (I think SLS has posted on this). It's on my list.
Ta,
Jah.
Posted by S.D. on January 13, 2001, at 19:52:37
In reply to Depakote for dysthymia?, posted by JahL on January 12, 2001, at 13:51:49
> What I'd like to know is, has anyone successfully treated UNIpolar depression with this stuff (alone)?
> I am particularly concerned with treating anhedonia/cognitive dysfunction.
>I still haven't seen any journal articles, but with phillybob's excerpt from dr. Hume ( http://www.pshrink.com/wisdom/bipolar_disorder.html ), I now have seen two doctors' opinions from experience with multiple patients (the 2nd being dr. jim phelps http://www.psycheducation.org/bipolar/02_diagnosis_app.html#Anchor-GAD-25741 ) and another's (dr. martin t. jensen http://www.drjensen.com/method3d.html ) example of a single patient.
I think you probably know of these already but I thought I'd put the links to all three in a reply here.
None of these mention anhedonia specifically, but the 2nd and 3rd do specifically mention poor concentration. That may be a clue if it is similar to the cognitive dysfunction you mention.
Also the 2nd and 3rd both mention anxiety and either irritability or anger. So if you have these, it may be another indication that mood stabilizers are likely.
Unfortunately my suspicion is that identical presentations can have any of several causes, or at least may require any one of many possible (unknowable a priori) med combos.
S.D.
Posted by JahL on January 15, 2001, at 12:39:25
In reply to maybe esp if w/ anxiety(Re: Depakote for dysth...) » JahL, posted by S.D. on January 13, 2001, at 19:52:37
> > > What I'd like to know is, has anyone successfully treated UNIpolar depression with this stuff (alone)?
> > > I am particularly concerned with treating anhedonia/cognitive dysfunction.
> I still haven't seen any journal articles, but with phillybob's excerpt from dr. Hume ( http://www.pshrink.com/wisdom/bipolar_disorder.html ), I now have seen two doctors' opinions from experience with multiple patients (the 2nd being dr. jim phelps http://www.psycheducation.org/bipolar/02_diagnosis_app.html#Anchor-GAD-25741 ) and another's (dr. martin t. jensen http://www.drjensen.com/method3d.html ) example of a single patient.
> None of these mention anhedonia specifically, but the 2nd and 3rd do specifically mention poor concentration. That may be a clue if it is similar to the cognitive dysfunction you mention.
>
> Also the 2nd and 3rd both mention anxiety and either irritability or anger. So if you have these, it may be another indication that mood stabilizers are likely.
>
> Unfortunately my suspicion is that identical presentations can have any of several causes, or at least may require any one of many possible (unknowable a priori) med combos.
>
> S.D.Dear S.D.
Thanx 4 the links; I hadn't seen the Jim Phelps article, which I found compelling reading.
He suggests that profound insomnia & concentration difficulties (always the hallmarks of my depression) are the primary indicators of good mood stabilizer response (& are suggetive of possible Bipolar-II dx in context of failed AD trials).
His description of Bipolar-II replicates my symptomology precisely; I have free-floating anxiety (racing thoughts/restlessness+social phobia) & am generally an extremely agitated/irritable individual. As far as anger goes, well I am the archetypal Angry Young(ish) Man! (The "Dysphoria" he mentions describes my anhedonia)
Phelps' comments on the nature of the concentration difficulties faced by Bipolar-IIs were also worryingly accurate.
In short, this article has given me some heart, suggesting as it does (like yourself) that mood stabilizers are quite possibly indicated in my case. It will make sticking to some decent-length trials (say Lamotrigine, Topiramate & maybe Gabapentin) that bit easier.
Perhaps the *addition* of an SSRI would more directly address the anhedonia issue??
Ta,
Jah.
This is the end of the thread.
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