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Dr. Bob is Robert Hsiung, MD,
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Posted by Dima on August 21, 2010, at 12:13:33
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 20, 2010, at 17:48:27
> It sounds like major depression. Depression does not necessary mean that you will feel 'sad'. Many of the symptoms which you mention are very typical of depression eg. lack of enjoyment of anything (anhedonia), constant feeling of distress which is difficult to describe and not clearly caused by any external situation, difficulty concentrating, loss of libido, low energy and insomnia.
>
> Can you tell us more about the blurry thoughts which are jumping around your head? I know this is difficult to describe. Are the thoughts very repetitive?
>
> Also, did you experience any symptoms when you were a young child or only as a teenager? Any symptoms noticed by your family or teachers?
>
> Finally, have you ever experienced periods where you felt very excited, impulsive, or energetic? Thoughts racing through your head, many new ideas, rapid speech, reduced need to sleep?
Thoughts are usually more ideas than actual sentences. I can't steer my thoughts how I'd like for very long. I guess it's brain fog, probably. Not much is repetitive unless I'm worried about something specific.The only symptoms people notice are me being quiet and irritable. Ever since at least kindergarden, I've been shy and not that happy. It was hard to notice because it happened so slowly, but I may have been getting worse. It's very hard to remember how I felt that long ago.
In December, after going low carb, I had a week of the only period that might be considered manic. I don't think I was, though. I felt close to normal, doing normal errands and not hating it.
Also, I don't think I mentioned that I feel almost no emotion. I didn't feel sad when my mom died in 2006. It's very hard to enjoy tv when your favorite tv show might as well be cspan because I don't feel any of the characters' emotions.
Thanks ed.
Posted by ed_uk2010 on August 21, 2010, at 15:23:28
In reply to Re: I feel horrible, posted by Dima on August 21, 2010, at 12:13:33
>Thoughts are usually more ideas than actual sentences. I can't steer my thoughts how I'd like for very long. I guess it's brain fog, probably. Not much is repetitive unless I'm worried about something specific.
That sounds typical of depression. Difficulties with concentration are very common in depression. There can be medical reasons for poor concentration, but I think you said that your doctor had done some blood tests. Poor concentration is seen in ADHD, but ADHD is not associated with severe mood disturbances or anhedonia. Poor concentration is seen in OCD - but this is due to constant repetitive and intrusive ideas which cause distress. Poor concentration in mania is due to rapid flight of ideas, distractability and excitement. Only major depression seems to fit your symptoms.
It seems to me that your anxiety is secondary to the depression, which appears to be your main problem. The depression makes social situations very unpleasant and difficult to deal with, which causes anxiety.
>The only symptoms people notice are me being quiet and irritable. Ever since at least kindergarden, I've been shy and not that happy.I see. This is obviously a very long term problem.
May I ask... when you are very depressed, do you ever hear voices or feel paranoid? Do you ever feel that other people are out to get you?
>In December, after going low carb, I had a week of the only period that might be considered manic. I don't think I was, though. I felt close to normal, doing normal errands and not hating it.
I don't think that sounds like mania. Did anyone comment that your behaviour during this period was unusual?
>Also, I don't think I mentioned that I feel almost no emotion.
In depression, emotional reactions are changed. Anger, irritability and distress may be felt, but not necessarily sadness. It's all very individual. Some people just feel numb, with no pleasure in anything. Also, certain medications can worsen the feelings of numbness.
How do you respond to tricyclic antidepressants such clomipramine? These drugs are sometimes suitable for severe depression when SSRIs haven't been effective. This could be something to discuss with your doctor.
This might not be what you want to hear right now but..... antidepressants in general don't seem to work as well in young people as they do in older adults. For example, the efficacy of antidepressants in teenagers is very modest. I am wondering whether you might respond much better to ADs in a few years time compared with how you respond now. I hope this gives some hope for the future.
Posted by Dima on August 21, 2010, at 17:23:55
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 21, 2010, at 15:23:28
> >Thoughts are usually more ideas than actual sentences. I can't steer my thoughts how I'd like for very long. I guess it's brain fog, probably. Not much is repetitive unless I'm worried about something specific.
>
> That sounds typical of depression. Difficulties with concentration are very common in depression. There can be medical reasons for poor concentration, but I think you said that your doctor had done some blood tests. Poor concentration is seen in ADHD, but ADHD is not associated with severe mood disturbances or anhedonia. Poor concentration is seen in OCD - but this is due to constant repetitive and intrusive ideas which cause distress. Poor concentration in mania is due to rapid flight of ideas, distractability and excitement. Only major depression seems to fit your symptoms.
>
> It seems to me that your anxiety is secondary to the depression, which appears to be your main problem. The depression makes social situations very unpleasant and difficult to deal with, which causes anxiety.
>
> >The only symptoms people notice are me being quiet and irritable. Ever since at least kindergarden, I've been shy and not that happy.
>
> I see. This is obviously a very long term problem.
>
> May I ask... when you are very depressed, do you ever hear voices or feel paranoid? Do you ever feel that other people are out to get you?
>
> >In December, after going low carb, I had a week of the only period that might be considered manic. I don't think I was, though. I felt close to normal, doing normal errands and not hating it.
>
> I don't think that sounds like mania. Did anyone comment that your behaviour during this period was unusual?
>
> >Also, I don't think I mentioned that I feel almost no emotion.
>
> In depression, emotional reactions are changed. Anger, irritability and distress may be felt, but not necessarily sadness. It's all very individual. Some people just feel numb, with no pleasure in anything. Also, certain medications can worsen the feelings of numbness.
>
> How do you respond to tricyclic antidepressants such clomipramine? These drugs are sometimes suitable for severe depression when SSRIs haven't been effective. This could be something to discuss with your doctor.
>
> This might not be what you want to hear right now but..... antidepressants in general don't seem to work as well in young people as they do in older adults. For example, the efficacy of antidepressants in teenagers is very modest. I am wondering whether you might respond much better to ADs in a few years time compared with how you respond now. I hope this gives some hope for the future.
>
I don't ever hear voices, but I feel paranoid in the sense that I feel like everyone is judging me. Not that they are out to get me.And there is also some OCD. For a few years I dealt with HOCD where I couldn't stop my mind from fearing that I'm gay everytime anything reminded me of being gay, sometimes even just a guy on TV. That was the main thought that would play back in circles for long periods of time. There have been some other similar thought patterns, but that was the main one. It doesn't feel like I got over it, though, it just feels like my mind is so turned off that I can't feel it anymore. It comes back in tiny degrees at random times, so I know it's at least somewhat still an issue.
Posted by morgan miller on August 21, 2010, at 17:49:59
In reply to Re: I feel horrible, posted by Dima on August 21, 2010, at 17:23:55
Hey Dima, sorry if I am annoying you with this, please tell me if I am and I will bug off...Have you ever seen a therapist? Are you open to the idea of therapy?
It just sounds like something may have triggered much of what you are experiencing at a very young age. I'm not judging, just saying it's a possibility that might be worth exploring. Personally, I believe that everyone that suffers from mental illness has influences from their childhood that contributed to the development of the mental illness.
Morgan
Posted by Dima on August 21, 2010, at 18:01:11
In reply to Re: I feel horrible, posted by morgan miller on August 21, 2010, at 17:49:59
> Hey Dima, sorry if I am annoying you with this, please tell me if I am and I will bug off...Have you ever seen a therapist? Are you open to the idea of therapy?
>
> It just sounds like something may have triggered much of what you are experiencing at a very young age. I'm not judging, just saying it's a possibility that might be worth exploring. Personally, I believe that everyone that suffers from mental illness has influences from their childhood that contributed to the development of the mental illness.
>
> MorganI've been seeing a therapist for a couple months. There's been no benefit at all from it. I'm not arguing that therapy can't help. It's just not helping me now. I can barely tell what my own thoughts are and can't find meaning in any of my thoughts. Specifically trying to find specific thought patterns makes my mind go even more blank.
I would love to feel better doing therapy so that it might actually help me. I thought Adderall might help me, but it seems that my depression is too tough for 10 mg to even put a dent in.
Posted by Dima on August 21, 2010, at 19:16:56
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 21, 2010, at 15:23:28
I've been basically no carb for two weeks. I've been checking my blood sugar for the past couple days, and the levels vary often ranging from 93 to 150 even many hours after meals it goes up and down.
Posted by Phillipa on August 21, 2010, at 20:16:00
In reply to Re: I feel horrible, posted by Dima on August 21, 2010, at 19:16:56
I'd advise a work up with an endocrinologist as if your blood sugars are off that could explain a lot of what you are experiencing. Phillipa
Posted by morgan miller on August 21, 2010, at 20:45:28
In reply to Re: I feel horrible, posted by Dima on August 21, 2010, at 18:01:11
Gotchya..Yeah you definitely need to be able to function normally and feel somewhat lucid in order to do the necessary work in therapy that will help in the long run.
Morgan
Posted by morgan miller on August 21, 2010, at 21:09:58
In reply to Re: I feel horrible, posted by Dima on August 21, 2010, at 19:16:56
Have you tried Zyprexa? I'm thinking a low dose may help stabilize you until you figure out a better long term treatment.
Too bad ketamine isn't available as a prescription yet. It really sounds like a dose of ketamine could really help you right now.
Are you open to trying some natural things for the time being that may help some? I'm thinking of fish oil, magnesium glycinate, L Glutamine, GABA, B6(with glutamine and GABA) Holy Basil, and Lithium Orotate. Or, are you thinking that if medications aren't helping then how could amino acids and other natural things help? I think these and other more natural substances would give your brain some nutrients it needs that may help medications work better, especially fish oil. Right now your brain is not responding well to many things and it needs some help-supplements, nutrition, and exercise(I realize this may be hard to do right now, but if you could just get your running shoes on and go run your *ss off for 20 mins then relax and stretch for another 15 mins you might just feel a little better).
I hope you find something that works for you soon.
Morgan
Posted by ed_uk2010 on August 22, 2010, at 15:49:25
In reply to Re: I feel horrible, posted by Dima on August 21, 2010, at 17:23:55
>And there is also some OCD. For a few years I dealt with HOCD where I couldn't stop my mind from fearing that I'm gay everytime anything reminded me of being gay, sometimes even just a guy on TV.
HOCD, I've not heard that one before. What would happen if you were gay? Would that be so awful? I don't think it would, not that I'm saying you are.
Anyway, I think you might benefit from a tricyclic antidepressant. TCAs are the traditional choice for severe depression. I think you may benefit - other meds don't seem to be helping. I suggest clomipramine because it is effective for anxiety as well as for depression. I think it would be helpful to discuss this with your psychiatrist. The initial dose of clomipramine for those who haven't taken it before is normally 25mg at night.
Posted by Phillipa on August 22, 2010, at 20:19:20
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 22, 2010, at 15:49:25
Never heard of HOCD either? Phillipa
Posted by ed_uk2010 on August 23, 2010, at 13:41:57
In reply to Re: I feel horrible » ed_uk2010, posted by Phillipa on August 22, 2010, at 20:19:20
>Never heard of HOCD either? Phillipa
Homosexual OCD, I guess?
I think the way to solve this one is to think... wait a minute, if I was gay, what would happen that would be so bad?
Posted by Dima on August 23, 2010, at 14:20:57
In reply to Re: I feel horrible » Phillipa, posted by ed_uk2010 on August 23, 2010, at 13:41:57
I understand that it's an irrational fear, that's why it's OCD. I thought it meant I was just gay and scared to accept it but I did some research and there are others who experience the same thing. At this point, there is virtually none of that thinking, though. It was horrible.
There's a terrible anxious feeling in my chest now for the past few days. It's worst when I wake up.
Posted by ed_uk2010 on August 23, 2010, at 14:55:50
In reply to Re: I feel horrible, posted by Dima on August 23, 2010, at 14:20:57
>I thought it meant I was just gay and scared to accept it....
Not necessarily. You're not alone is experiencing those kind of thoughts.
>There's a terrible anxious feeling in my chest now for the past few days. It's worst when I wake up.
I'm sorry to hear that. When do you next see your pdoc?
Posted by Dima on August 23, 2010, at 15:41:52
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 23, 2010, at 14:55:50
I'm scheduled to see her on the 19th, but I see my therapist next Monday. My doctor told me to find her when I see my therapist to get a refill on the Adderall.
The Adderall barely does anything for me, even at 30 mg, so I'm not too hopeful about that.
She thinks I'm taking Celexa, Remeron, Lithium, and Seroquel, but I'm only taking Lithium. Should I suggest switching out the Celexa and Remeron for the TCA you were talking about? Maybe Parnate would help more? Do you know of any references about that TCA that I could show her?
Posted by ed_uk2010 on August 23, 2010, at 17:17:18
In reply to Re: I feel horrible, posted by Dima on August 23, 2010, at 15:41:52
>The Adderall barely does anything for me, even at 30 mg, so I'm not too hopeful about that.
In that case, it might be best to stop taking it. There's no point risking dependence on a medication which isn't helping.
>She thinks I'm taking Celexa, Remeron, Lithium, and Seroquel, but I'm only taking Lithium. Should I suggest switching out the Celexa and Remeron for the TCA you were talking about?
You could do. It's just a suggestion. Here is some information from Dr. Gillman. He mentions the DUAG studies (Danish University Antidepressant Group). These studies suggested that clomipramine is more effective than citalopram, and also more effective than other tricyclics.
http://www.psychotropical.com/Antidepressants_Clomipramine.shtml
>Maybe Parnate would help more?
Maybe, maybe not. It is usual to try a couple of tricyclics before considering MAOIs. This is mainly due to the dietary restrictions and drug interactions associated with MAOIs.
Posted by Phillipa on August 23, 2010, at 20:36:59
In reply to Re: I feel horrible » Phillipa, posted by ed_uk2010 on August 23, 2010, at 13:41:57
Ed now why could that possibly be bad? It's perfectly fine to me. Love PJxxx
Posted by Dima on August 24, 2010, at 10:54:34
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 23, 2010, at 17:17:18
I tried Effexor for eight weeks with no effect and that page says they're pretty similar. Is it worth a try?
> >The Adderall barely does anything for me, even at 30 mg, so I'm not too hopeful about that.
>
> In that case, it might be best to stop taking it. There's no point risking dependence on a medication which isn't helping.
>
> >She thinks I'm taking Celexa, Remeron, Lithium, and Seroquel, but I'm only taking Lithium. Should I suggest switching out the Celexa and Remeron for the TCA you were talking about?
>
> You could do. It's just a suggestion. Here is some information from Dr. Gillman. He mentions the DUAG studies (Danish University Antidepressant Group). These studies suggested that clomipramine is more effective than citalopram, and also more effective than other tricyclics.
>
> http://www.psychotropical.com/Antidepressants_Clomipramine.shtml
>
> >Maybe Parnate would help more?
>
> Maybe, maybe not. It is usual to try a couple of tricyclics before considering MAOIs. This is mainly due to the dietary restrictions and drug interactions associated with MAOIs.
>
>
Posted by ed_uk2010 on August 24, 2010, at 15:24:48
In reply to Re: I feel horrible, posted by Dima on August 24, 2010, at 10:54:34
> I tried Effexor for eight weeks with no effect and that page says they're pretty similar.
I don't think it does. If you look at his website, Dr. Gillman does not believe that Effexor is comparable to clomipramine. He believes that clomipramine is superior for severe depression. He indicates that Effexor is more similar to an SSRI.
So yes, I think it's worth a try. You must start at a fairly low dose (eg. 25mg at night) and increase in steps of 25mg. Dosage requirements vary considerably. Initiating treatment at a high dose is likely to cause a lot of side effects.
In the US, clomipramine (Anafranil) is approved as a treatment for OCD, not depression. This is entirely due to the fact that the manufacturer wanted to promote it as an anti-obsessional drug when it was first launched. In reality, it is effective both for depression and for OCD. In the UK and in most countries, it is approved for both conditions. It is at least as effective as other tricylic antidepressants for depression (and probably more effective than most).
What happened to the dopamine agonist that you started? Are you still taking it?
Posted by Dima on August 24, 2010, at 16:16:57
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 24, 2010, at 15:24:48
> > I tried Effexor for eight weeks with no effect and that page says they're pretty similar.
>
> I don't think it does. If you look at his website, Dr. Gillman does not believe that Effexor is comparable to clomipramine. He believes that clomipramine is superior for severe depression. He indicates that Effexor is more similar to an SSRI.
>
> So yes, I think it's worth a try. You must start at a fairly low dose (eg. 25mg at night) and increase in steps of 25mg. Dosage requirements vary considerably. Initiating treatment at a high dose is likely to cause a lot of side effects.
>
> In the US, clomipramine (Anafranil) is approved as a treatment for OCD, not depression. This is entirely due to the fact that the manufacturer wanted to promote it as an anti-obsessional drug when it was first launched. In reality, it is effective both for depression and for OCD. In the UK and in most countries, it is approved for both conditions. It is at least as effective as other tricylic antidepressants for depression (and probably more effective than most).
>
> What happened to the dopamine agonist that you started? Are you still taking it?
>
>
>
>No, I took it for about a week. It seemed to make me even more tired the entire day, and I saw no other effects. If it helped the RLS, I didn't care enough to notice.
I'll bring the page you showed me to my therapist's appointment, and maybe I can get a chance to talk to the doctor on that day as well.
I've cried three times in the past two days, which is very rare for me. It's a horrible feeling in my chest that keeps getting worse and worse until I cry, and I feel slightly better, but I don't even have the energy to cry for very long.
Posted by ed_uk2010 on August 25, 2010, at 14:32:34
In reply to Re: I feel horrible, posted by Dima on August 24, 2010, at 16:16:57
>I'll bring the page you showed me to my therapist's appointment, and maybe I can get a chance to talk to the doctor on that day as well.
That might help. I expect your doctor will say 'Oh, it's an old drug, we don't prescribe THAT anymore'..... here, have some samples of Seroquel XR.............but I could be wrong. Anafranil is indeed an old drug. You will never see an advert for it. No one is out there promoting it and giving doctors pens and mugs which say 'Anafranil'.
> I've cried three times in the past two days, which is very rare for me.If I feel really bad, I actually find it helpful to cry a little. It releases the tension somehow - all the tension that's built up.
Take care.
Posted by Dima on August 25, 2010, at 16:26:01
In reply to Re: I feel horrible, posted by ed_uk2010 on August 25, 2010, at 14:32:34
I went to the hospital last night for extremely bad depression and nonstop suicidal thoughts. They didn't really do anything and I went home at four in the morning. I saw a pdoc today and she prescribed Anafranil. So I'll be taking:
Morning: Lithium 300, Celexa 40
Evening: Seroquel 50, Anafranil 25, Lithium 300
She prescribed 50 mg of the Anafranil, but you think I should start at 25?
Posted by ed_uk2010 on August 25, 2010, at 17:41:08
In reply to Re: I feel horrible, posted by Dima on August 25, 2010, at 16:26:01
> Morning: Lithium 300, Celexa 40
>
> Evening: Seroquel 50, Anafranil 25, Lithium 300
>
> She prescribed 50 mg of the Anafranil, but you think I should start at 25?Hi Dima,
Taking Anafranil in combination with SSRIs such as citalopram is not normally recommended. Anafranil is a very potent serotonin reuptake inhibitor in its own right. Once you have started Anafranil, you will probably be able to taper off citalopram very quickly. Personally, I would reduce citalopram to 20mg immediately after starting Anafranil. After a few days, I would then reduce to 10mg........and then stop after a few more days. Please bear in mind that this is what I would do myself. I am not a doctor and this should not be taken as medical advice.
Anafranil often causes drowsiness, especially during the early stages of treatment. You may be able to stop Seroquel - ask your doctor. Taking all these meds together could make you feel very tired and 'out of it'! I think it would be best to simplify your regimen as much as possible.
I think you should start Anafranil at the lowest possible dose and increase gradually. You should expect some dry mouth, drowsiness, dizziness, tremor and sweating - clomipramine is a powerful medication. If the starting dose is too high, side effects are more likely. You need to give your body time to get used to the medication before you increase up to a therapeutic dose.
Listen to your body! If you experience strong side effects after starting clomipramine, this suggests that your blood level might already be high despite the low dose - in this case you should not increase until you have consulted your doctor. If you experience mild side effects, wait a few days and then increase in small steps. If you experience no side effects at all, you should be able to increase more rapidly.
Take care, and let us know how you get on. Best of luck.
Posted by Dima on August 25, 2010, at 18:05:42
In reply to Re: I feel horrible, posted by ed_uk2010 on August 25, 2010, at 17:41:08
Thanks, that makes sense. And I have been taking the Celexa for a couple months with no effect anyway. It was actually 20 mg before and she increased it to 40 along with lowering Seroquel to 50 and prescribing Anafranil.
Is it possible to have depression as a withdrawal symptom of Adderall for days? I think there's a chance that when I take the Adderall, I feel worse for a day or two, and yesterday's depression could have been caused by not taking the Adderall for two days. Or is that too much time after?
Posted by ed_uk2010 on August 26, 2010, at 1:48:25
In reply to Re: I feel horrible, posted by Dima on August 25, 2010, at 18:05:42
>It was actually 20 mg before and she increased it to 40 along with lowering Seroquel to 50 and prescribing Anafranil.
She doesn't want you to increase citalopram at the same time as starting Anafranil, does she? If you're starting Anafranil, you need to consider decreasing citalopram.
>Is it possible to have depression as a withdrawal symptom of Adderall........?
Amphetamine withdrawal can cause depressive symptoms, yes.
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