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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 13 to 37 of 37. Go back in thread:
Posted by OldSchool on March 28, 2002, at 11:16:06
In reply to Re: What causes med poopout the worst, posted by OldSchool on March 28, 2002, at 11:04:14
Developing depot injections of ADs would STOP this thing many depressives do with their meds. Playing games with meds, stopping and starting, going on and off the same med. Like if you got the depot injection of Prozac, it would last two weeks or whatever...like depot injections of anti-psychotics. Youd have no control over the med cause you couldnt take it pill form. Any changes you made would have to be confirmed with your psychiatrist.
Of course, these depot injections would be purely voluntary. When depot injections of antipsychotics are given, many times its not voluntary or its coerced, because psychosis is a totally different ball of wax than depression. My point is that long lasting depot injections of an AD would keep the AD in your system longterm and force many patients to "ride it out" in that early adjustment phase. If they could make it to week two or three, those rough early weeks, they can probably come out of the hole and recover.
Its just this thing where people take the pills, get side effects they dont like that oftentimes will go away after a while and they stop taking the med. Depot injections would solve that problem. Get the shot, it lasts two weeks, come back for another shot and in a month you are recovered. Very consistent blood levels of an antidepressant and the patient has no control over it except to consent to getting the shot.
Depot injections of antidepressants would mean a slow and steady maintenance of the drug in your system. Which is a good thing. No stopping and starting the same drug repeatedly.
I think its a good idea and would prevent a lot of poopout problems.Old School
Posted by Bob on March 28, 2002, at 12:32:01
In reply to I hear ya bro!! » Bob, posted by jay on March 28, 2002, at 5:41:15
I'm with you Jay. My life has degenerated to where any tinkering with the meds any longer sends me into a physical and mental tailspin. Meanwhile, I'm about 25-30 percent functional (on a decent day) on my current meds, but I'm real scared to change them anymore. I worked my ass off to get an engineering degree, and now 10 years later, I've finally had to go on disability. Eventually I won't even have that. All my friends and acquaintances have moved on with their lives; getting promoted in their careers, getting married, having children. It's extremely humbling, frustrating, and infuriating.
Bob
>
> I am at a point, again, of just being so tired, feeling so low and also so anxoety-prone, and all the damn "tinkering" of my medications. I started to cry when I pulled into my driveway this morning, from working at a job *that sucks*, making mimimum wage, when I have two college degrees, and 10+ years as a professional. I *thought* my meds where supposed to protect me from feeling so shitty...help motivate me to get a good job. Maybe walking around in a stoned haze isn't such a bad idea afterall. I *still* have yet to see anybody, besides some safety factors, prove alcohol and pot to less effective than most medications out there.
>
> /rant
>
> Jay
Posted by Bob on March 28, 2002, at 12:41:12
In reply to Re: psychiatry needs depot injections of ADs, posted by OldSchool on March 28, 2002, at 11:16:06
> Developing depot injections of ADs would STOP this thing many depressives do with their meds. Playing games with meds, stopping and starting, going on and off the same med. Like if you got the depot injection of Prozac, it would last two weeks or whatever...like depot injections of anti-psychotics. Youd have no control over the med cause you couldnt take it pill form. Any changes you made would have to be confirmed with your psychiatrist.
Sounds like a reasonable idea, but what about when a med produces significant akathisia, or suicidal agitation?
Posted by Bob on March 28, 2002, at 13:05:15
In reply to Re: What causes med poopout the worst, posted by OldSchool on March 28, 2002, at 10:59:31
> Let me explain it very very specifically Bob. Say you are on Remeron for major depression. Youve been on 15 mg Remeron for three weeks and your Pdoc bumps you up to 30 mg. After a week at 30 mg you find your really sedated and getting really fat. You are like "fuck this" so you drop back down to 15 mg on your own, indecisive as many severe depressives tend to me. You remain at 15 mg for a week, find your getting more depressed and realized you made a mistake. (more decision making problems common to severe depression and inability to think clearly) So you bump it back up to 30 mg, only to find that low and behold it doesnt activate good like it did the first time. Do this a third time and your meds will be like water...fadeout to the max.
>
> This is my point. Going on and off the same antidepressant within a short time period "does things" and in my opinion is one of the things that causes med poopout the worst of anything.
>
> thats why I tell depression "newbies" the best thing they can do for themselves when going on ADs is to play it slow and steady. Once on an AD, STAY on the AD and dont play games with your meds. Dont change the dosage yourself, dont be wishy washy and decide one day you dont need the AD, only to find out two weeks later your depressed as dirt again and really do need the med. Only when returning to the med, you find out its losts its punch.
>
> See what I mean...this combination of denial so many have (stopping their meds) along with hating side effects which leads to stopping meds, then when reality hits later, many find that their meds no longer work good anymore.
>
> this is a big reason for antidepressant poopout in my personal opinion.
>
> Old SchoolI guess the main point I missed was coming on and off the *same* drug. I still have a problem with it though, because the scenario you described above with the Remeron is symptomatic of human nature. People aren't doing these things for shits and giggles, but because it's human nature - they can't help it. In fact, I often read stories about how mere compliance with taking a pill once a day is not very well adhered to for a majority of the population. I personally cannot afford that luxury any longer, as that would blow away what little stability I have. If I miss any doses, I feel it.
Possibly the "depot injections" you have suggested would be viable alternative, but I would think very few people would be up to opting for an injection over a pill.
Do you think ECT would renew a person's response to a med they had "worn out" by going on and off?
Posted by Bob on March 28, 2002, at 13:20:12
In reply to Re: I hear ya bro!! » jay, posted by Zo on March 28, 2002, at 8:11:19
> Well, THAT'S depression talking. You are depressed, child. List me all your meds. We can do waaay better than that.
>
> ZoI'm not so sure, Zo. I've been on well over 20 psychotropics with from bad to worse luck. The only class I haven't dabbled in is MAOIs, and I honestly don't think I could survive the washout period. From past experience I would become very suicidal, very quickly. I have no desire to spend a month in a hospital wanting to die every second only to find out that MAOIs aren't any better than what I've tried. Then I'd have to go through another washout period to get off of them.
I've been on every SSRI, Effexor, Anafranil, Depakote, stimulants, Tegretol, Trileptal, Lamictal, and Topomax. That last one very nearly killed me. I've also tried many other meds, including Lithium although not for extremely long trials (only about a month or so). Many of the meds I've tried for several months at a minimum, and some for up to two years. It's been 10 years of this.
I'm currently squeaking by on Celexa and Klonopin, and am contemplating ECT. I now fear new drug trials and the transition periods that they bring. I can't afford another fantastic failure of a drug trial.
Posted by OldSchool on March 28, 2002, at 13:24:07
In reply to Re: What causes med poopout the worst » OldSchool, posted by Bob on March 28, 2002, at 13:05:15
>
> I guess the main point I missed was coming on and off the *same* drug. I still have a problem with it though, because the scenario you described above with the Remeron is symptomatic of human nature. People aren't doing these things for shits and giggles, but because it's human nature - they can't help it. In fact, I often read stories about how mere compliance with taking a pill once a day is not very well adhered to for a majority of the population. I personally cannot afford that luxury any longer, as that would blow away what little stability I have. If I miss any doses, I feel it.
>
> Possibly the "depot injections" you have suggested would be viable alternative, but I would think very few people would be up to opting for an injection over a pill.
>
> Do you think ECT would renew a person's response to a med they had "worn out" by going on and off?I have no idea Bob. Some say ECT "renews" good response to meds, others say you need maintenance ECT to maintain the effect. Like all things in psychiatry, its all subjective and nobody really knows.
Old School
Posted by Bob on March 28, 2002, at 13:35:09
In reply to Re: What causes med poopout the worst, posted by OldSchool on March 28, 2002, at 13:24:07
> I have no idea Bob. Some say ECT "renews" good response to meds, others say you need maintenance ECT to maintain the effect. Like all things in psychiatry, its all subjective and nobody really knows.
>
> Old SchoolYeah... tell me about it. Are you still considering ECT, like you said before?
Bob
Posted by Bob on March 28, 2002, at 13:46:53
In reply to Re: I hear ya bro!! » jay, posted by Zo on March 28, 2002, at 8:11:19
> Well, THAT'S depression talking. You are depressed, child. List me all your meds. We can do waaay better than that.
>
> ZoZo:
Sorry my list of meds wasn't very detailed, but it would be an EXTREMELY long post to describe all my symptoms, med history, symptoms, side effects and reactions. If I feel better later I will do it. If you ask more specific questions I'll answer. I will tell you that my dx includes OCD, significant GAD, and depression. I am quite "med intolerant".
Bob
Posted by OldSchool on March 28, 2002, at 14:06:12
In reply to Re: What causes med poopout the worst » OldSchool, posted by Bob on March 28, 2002, at 13:35:09
>
> > I have no idea Bob. Some say ECT "renews" good response to meds, others say you need maintenance ECT to maintain the effect. Like all things in psychiatry, its all subjective and nobody really knows.
> >
> > Old School
>
> Yeah... tell me about it. Are you still considering ECT, like you said before?
>
> Bob
Yes definitely. In fact I talked about ECT extensively yesterday with my family doctor and even my family doctor thinks ECT is an awesome idea for me. He claims it should be used as a "first line" depression treatment but isnt because of the stigma and such. Right now Im working on getting my BP back under control and as soon as that is done I will be having ECT. Sometime in the next two months I guess...very possibly by the end of April.Old School
Posted by JohnX2 on March 28, 2002, at 14:25:28
In reply to Re: What causes med poopout the worst » JohnX2, posted by Zo on March 28, 2002, at 8:08:28
> Then I think we have to redefine what Stops Working is.
>
> Maybe it's the whole wrong point of view. Maybe people are, like me, actually dealing with a mood disorder, so that their subjective experience is of "stopping" and "pooping out". . and what's really going on, well, it coulde be any number of things. Not the right med. Helped a little but didn't work. The right med at the wrong dose. The right med if augmented. Ramped up too fast. Internal chemistry shifted, so it appears the drug pooped out, when the body is ready to move along to something else. Or, just plain, wrong dx.
>
> I dunno, just offering a little paradigm shift, you might be barking a little too loud up the wrong tree. A little barking is natural. . .but my abiding sense is that Poop-out thinking is a potential dead end. If you know what I mean. ..
>
> Zo
I apologize. I'm focusing on people who have had 100% remissions on medicines for a few wonderful days and had lost this and never regained this (even after going various dx's and many medication routes for decades). These people deserve a shot at a full sustained remision, and the medical system has not spent diddly studying the problem (tachyphylaxis) for them.This is not the general population. Poop out for the general pop is taking the med for many months and then having it petered out, I am focusing with a few select TRD people to better help them understand their problem. The people with money to study the problem have no financial motivation to do so.
I myself experienced a remission from depression that I can not describe in words how wonderful it felt 3 times on Ads (which petered in hours or days) that I don't know if i will ever recapture.
Note, this petering was biological and not psychological. I can just accept this and take my current regimen of meds which leaves me mostly functional?John
Posted by Bob on March 28, 2002, at 14:25:53
In reply to Re: What causes med poopout the worst, posted by OldSchool on March 28, 2002, at 14:06:12
> >
> > > I have no idea Bob. Some say ECT "renews" good response to meds, others say you need maintenance ECT to maintain the effect. Like all things in psychiatry, its all subjective and nobody really knows.
> > >
> > > Old School
> >
> > Yeah... tell me about it. Are you still considering ECT, like you said before?
> >
> > Bob
>
>
> Yes definitely. In fact I talked about ECT extensively yesterday with my family doctor and even my family doctor thinks ECT is an awesome idea for me. He claims it should be used as a "first line" depression treatment but isnt because of the stigma and such. Right now Im working on getting my BP back under control and as soon as that is done I will be having ECT. Sometime in the next two months I guess...very possibly by the end of April.
>
> Old SchoolI hope you keep us posted on your progress if you have that, as I would be very interested in knowing how it works out.
What area of the country do you reside in, if you don't mind me asking?
Bob
Posted by polarbear206 on March 28, 2002, at 17:31:17
In reply to What causes med poopout the worst, posted by OldSchool on March 27, 2002, at 21:04:17
> On this site there is much discussion of why antidepressants poop out or "fade out" or whatever you wish to call it. Some claim its caused by gradual dopaminergic depletion, as is seen with longterm use of SSRIs or atypical anti-psychotics. Others claim its subtle bipolar traits that can be solved with the addition of lithium or lamictal.
>
> However, I have my own personal beliefs concerning the biggest reason why meds poop out. I believe the SINGLE biggest reason why ADs stop working good is what I dub the "start and stop" phenomenon. When you go on an antidepressant for a while, even for a short period of a few weeks, then stop it, then restart it, it seems like it almost never has the same original "punch" or activation it had in the beginning. one of my psychiatrists once told me that repeatedly starting and stopping the same antidepressant, particularly within a short time frame, was one of the worst things you can do if you are depressed. I agree with him. He told me that doing this, "does things" which makes the meds not work good.
>
> That has been my experience. More than anything else Ive done, starting and stopping a med makes it not work good anymore.
>
> Old School
What causes med poopout? Probably in many people is an underlying bipolar spectrum disorder. I see it all the time. I'm a psychiatric nurse and have seen dramatic results in several individuals who were started on mood stabilizers in addition to their antidepressant medication. There are so many people out there that are walking around with the wrong diagnosis. I suggest you read this book; "Why your depression isn't getting better" This is an excellent book about the epidimic of undiagnosed bipolar disorders. The author is Michael R. Bartos MD. There is a very broad spectrum to bipolar disorders that many people are unaware of.
Posted by OldSchool on March 28, 2002, at 18:27:30
In reply to Re: What causes med poopout the worst » OldSchool, posted by Bob on March 28, 2002, at 14:25:53
>
>
> What area of the country do you reside in, if you don't mind me asking?
>
I live in a third world country Bob, its called Pineland. No seriously, I live in North Carolina but the third world country analogy is in certain ways accurate.Old School
Posted by tye on March 28, 2002, at 18:29:44
In reply to Re: What causes med poopout the worst, posted by polarbear206 on March 28, 2002, at 17:31:17
> What causes med poopout? Probably in many people is an underlying bipolar spectrum disorder. I see it all the time. I'm a psychiatric nurse and have seen dramatic results in several individuals who were started on mood stabilizers in addition to their antidepressant medication. There are so many people out there that are walking around with the wrong diagnosis. I suggest you read this book; "Why your depression isn't getting better" This is an excellent book about the epidimic of undiagnosed bipolar disorders. The author is Michael R. Bartos MD. There is a very broad spectrum to bipolar disorders that many people are unaware of.
Dear Polarbear,I have not responded to antidepressants. Will any mood stabilizer help a depressed individual with an underlying bipolar spectrum disorder? Or does it have to be lithium or lamictal (Mood stablizers with antidepressant activity)?
Thanks,
Tye
Posted by tye on March 28, 2002, at 18:48:25
In reply to What causes med poopout the worst, posted by OldSchool on March 27, 2002, at 21:04:17
> However, I have my own personal beliefs concerning the biggest reason why meds poop out. I believe the SINGLE biggest reason why ADs stop working good is what I dub the "start and stop" phenomenon. When you go on an antidepressant for a while, even for a short period of a few weeks, then stop it, then restart it, it seems like it almost never has the same original "punch" or activation it had in the beginning. one of my psychiatrists once told me that repeatedly starting and stopping the same antidepressant, particularly within a short time frame, was one of the worst things you can do if you are depressed. I agree with him. He told me that doing this, "does things" which makes the meds not work good.
>
> That has been my experience. More than anything else Ive done, starting and stopping a med makes it not work good anymore.
>
> Old SchoolDear O.S.,
I don't think loss of response is secondary to inconsistantly taking antidepressants. I don't think the body builds up tolerance or immunity to antidepressants. I think this idea of tolerance stems from bacteria's ablity to develope resistance to antibiotics. Some people will say like antibiotics, if antidepressants are started and stopped repeatedly, they lose effectiveness because the body is becomes immune.
I don't think brain cells behave like bacteria. I don't believe they acquire resistance to the actions of antidepressants. Probably, like most neurologic disease, it is the brain pathology progressing which causes poop out. For example, levodopa does not poop out in the brains of parkinson's patients. The disease process evolves so eventually levodopa does not work anymore.
Tye
Posted by OldSchool on March 28, 2002, at 20:26:24
In reply to Maybe your disease is changing? » OldSchool, posted by tye on March 28, 2002, at 18:48:25
>
> >
> I don't think loss of response is secondary to inconsistantly taking antidepressants.I do. Try going on and off the same antidepressant a few times in a short time frame. I practically guarantee you that by the second or third time you go back to it, it wont activate good anymore. This is a drug/physiology thing, nothing else. Im not talking about taking antidepressants inconsistently, I am talking about starting and stopping them repeatedly as some people do. Im telling you, this does BAD things to antidepressant activation.
Old School
Posted by OldSchool on March 28, 2002, at 20:39:08
In reply to Re: What causes med poopout the worst, posted by polarbear206 on March 28, 2002, at 17:31:17
>
> What causes med poopout? Probably in many people is an underlying bipolar spectrum disorder. I see it all the time. I'm a psychiatric nurse and have seen dramatic results in several individuals who were started on mood stabilizers in addition to their antidepressant medication. There are so many people out there that are walking around with the wrong diagnosis. I suggest you read this book; "Why your depression isn't getting better" This is an excellent book about the epidimic of undiagnosed bipolar disorders. The author is Michael R. Bartos MD. There is a very broad spectrum to bipolar disorders that many people are unaware of.Hmmmmmm that sounds like an interesting book I will have to check out. Im not so sure I agree with the idea that bipolar disorder masquarades as panic attacks or hyperactivity...manic depression is clearly attributed to highs and lows...mood swings are the ultimate hallmark of bipolar disorder. however it looks like an interesting book.
http://www.amazon.com/exec/obidos/ASIN/0595122094/drbobsvirte00-20
Of course, lithium augmentation of an antidepressant is probably the most common augmentation strategy for TRD unipolar major depression. Also, lamictal is increasingly being used. As for me, Ive tried adding depakote, neurontin and lithium to various antidepressants I was on at the time and all they did was flatten me out more, bring me down more and generally make me more depressed. However I agree for some TRD individuals mood stabilisers is a very useful "big gun" strategy.
Im sure the developing high technology of functional neuroimaging will shed much light on the varying "degrees" of bipolarity.
The best "big gun" strategy for TRD is ECT. Hehehe.
Posted by JohnX2 on March 28, 2002, at 21:49:36
In reply to Re: Maybe your disease is changing?, posted by OldSchool on March 28, 2002, at 20:26:24
> >
> > >
> > I don't think loss of response is secondary to inconsistantly taking antidepressants.
>
> I do. Try going on and off the same antidepressant a few times in a short time frame. I practically guarantee you that by the second or third time you go back to it, it wont activate good anymore. This is a drug/physiology thing, nothing else. Im not talking about taking antidepressants inconsistently, I am talking about starting and stopping them repeatedly as some people do. Im telling you, this does BAD things to antidepressant activation.
>
> Old School
How do you know this? (note : I am not taking a position for or against)John
Posted by OldSchool on March 28, 2002, at 22:06:38
In reply to Re: Maybe your disease is changing? » OldSchool, posted by JohnX2 on March 28, 2002, at 21:49:36
> How do you know this? (note : I am not taking a position for or against)
>
> JohnBecause it happened to me and I have also read where its happened to other people.
Posted by JohnX2 on March 28, 2002, at 23:05:18
In reply to Re: Maybe your disease is changing?, posted by OldSchool on March 28, 2002, at 22:06:38
> > How do you know this? (note : I am not taking a position for or against)
> >
> > John
>
> Because it happened to me and I have also read where its happened to other people.OldSchool,
I guess I don't follow the thread.
Are we saying that the AD has already kickstarted (I.e. we feel happy), and then it was discontinued and recontinued. Or are we saying that we are in the weeks before the AD even really kicks in?
John
Posted by Bob on March 29, 2002, at 0:23:13
In reply to Re: What causes med poopout the worst, posted by OldSchool on March 28, 2002, at 18:27:30
> >
> >
> > What area of the country do you reside in, if you don't mind me asking?
> >
>
>
> I live in a third world country Bob, its called Pineland. No seriously, I live in North Carolina but the third world country analogy is in certain ways accurate.
>
> Old SchoolI would guess that depends on what area of NC you're from. I'm in MD.
Bob
Posted by jay on March 30, 2002, at 12:16:26
In reply to Re: I hear ya bro!! » jay, posted by Zo on March 28, 2002, at 8:11:19
> Well, THAT'S depression talking. You are depressed, child. List me all your meds. We can do waaay better than that.
>
> ZoYep...you are *so* right. Here is what I was on:
225 mg Effexor XR
5mg Zyprexa
150 mg Welbutrin SRI have cut way back on the Effexor...maybe taper off, and knocked out the Zyprexa. I have also cut my Welbutrin down to 75 mg from 150. (I know you aren't supposed to chop up the SR tablets, but I found if you take them twice a day like the regular stuff, it is just as fine.)
I have a bit of clonazepam left over that I may add to my mix, as I am re-starting the Welbutrin. I had stopped the 150 after two days because I felt so horrible on it.
Anyhow...that's what's going on. Like everything in life...trial and error. I am gonna try a few other things I always suggest to folks. (Preach but I don't practise...good one, eh?..hehe) A 'little' bit of exercise...not too much to wind up the anxiety. Make up a couple of cd's with songs that help me through the crud.
I will report for duty later on..:) Thanx for asking...and thanx for the concern. BTW...how are *you* doing these days? Please and thank-you...
Jay
Posted by Dave1 on March 31, 2002, at 21:15:41
In reply to Re: What causes med poopout the worst » OldSchool, posted by JohnX2 on March 27, 2002, at 22:31:56
John,
I've had several quick poop outs. Once, I started taking risperdal for a delusional idea that I had had for years. After several days on risperdal, the delusion went away. But, several days after that, the delusion came back.
Next, I'm currently taking anafranil and lithium. I increased my lithium a couple of weeks ago and my depression subsided some. But, after a couple of days the depression was back in full force.
What do you think is going on here???
Thanks,
Dave
>
> What if it stops working at the same dose in a few days, hours, sometimes minutes as is the case in many TRDS on this newgroup?
>
> John
Posted by JohnX2 on April 1, 2002, at 4:49:08
In reply to Re: What causes med poopout the worst » JohnX2, posted by Dave1 on March 31, 2002, at 21:15:41
Sorry Dave, I don't have much insight to offer into your situation.John
> John,
>
> I've had several quick poop outs. Once, I started taking risperdal for a delusional idea that I had had for years. After several days on risperdal, the delusion went away. But, several days after that, the delusion came back.
>
> Next, I'm currently taking anafranil and lithium. I increased my lithium a couple of weeks ago and my depression subsided some. But, after a couple of days the depression was back in full force.
>
> What do you think is going on here???
>
> Thanks,
> Dave
>
>
>
>
> >
> > What if it stops working at the same dose in a few days, hours, sometimes minutes as is the case in many TRDS on this newgroup?
> >
> > John
Posted by Dave1 on April 1, 2002, at 8:34:24
In reply to Re: What causes med poopout the worst » Dave1, posted by JohnX2 on April 1, 2002, at 4:49:08
Thanks anyway,
I think I'll try to increase the LI, Anafranil or both and see if the depression lifts for a longer time.
Bye,
Dave
This is the end of the thread.
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