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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by violetdream on May 28, 2012, at 4:43:58
tldr alert, background!
Ok, so I have severe (what I think is) atypical treatment resistant depression, as well as general anxiety and Asperger's. I've suffered from crippling rejection sensitivity as well as mild BDD recently as well as symptoms of conversion disorder such as hysterical paralysis and transient aphasia during extreme stress. Very very rarely I will have mini manic/hypomanic episodes with uncontrollable laughter and then crash very badly after, but it's 99.999% the depression. I don't have OCD as such but I've had trichotillomania since I was very young as well as obsessive thoughts/rumination.
I've tried meds in probably every class with such a broad spectrum of symptoms that I was once labeled as mood disorder NOS. At a very early age I started low doses of anti-psychotics, which seemed to be the only thing that would barely touch my depression.
Anyway, things got worse and worse and working with my family we started to get more aggressive, I did a round of TMS (nothing) and then finally 20 bilateral sessions of ECT (nothing but gave me retrograde amnesia). However at this time I started the Emsam patch. It seemed to be working quickly and very well (infuriatingly MAOIs were the one thing I hadn't tried!) but it didn't quite do it for me so I decided to switch to Parnate. I was able, with the help of an incompetent doctor, get to 60mg, and now that I've found someone new I want to talk seriously about additional tests and possible augmentation I can do. I've been on 60mg of the Parnate for maybe a month and a half now and things haven't changed much, in fact have gotten a bit worse.
/tdlr
I'm looking to rule out any hidden medical causes of my depression. The only thing I have not done is have a comprehensive panel of many different specific tests. However, as I have had symptoms since puberty, there must be a genetic basis, but things have gotten so bad lately I feel something must be going on.Things I've done: I had an MRI last year, everything checked out. I got some blood tests done, showing a depletion in Vitamin D. I've since raised that to acceptable levels and along the way made sure to dose up on B vitamins. I'm in the process of raising my iron levels, they're within normal, but on the low side. I had a metabolic panel done and potassium looked great, which I was relieved by.
Things I haven't done: I got some kind of thyroid test, but not a comprehensive one, quite a while ago. Here are some physical symptoms I have that I'm wondering would contribute to the depression that, as far as I know, doctors have never looked into thoroughly.
1. Chronic tachycardia (some kind of thyroid issue?) I am *always* running around at least 100bpm with no activity/stress.
2. Possible PCOS, non diagnosed, but I've had such awful dysmenorrhea that I've been on continuous birth control most of my life (I've never noticed any mood changes when going off, though), as well as hard to control acne and metabolic syndrome (very high cholesterol since I was too young to have it be due to food).
3. This one may be out here, but I was wondering about the use of medications that may possibly treat any neurotoxins and help with the ECT memory loss? I was thinking about this after I saw that minocycline had strong anti-inflammatory effects and passes the blood brain barrier. I'm not sure offhand of any "amnesia meds" but I know there must be something, and I've had cats long enough that I'm sure I have latent toxoplasmosis by now (which in one study was shown, while being associated with increased intelligence, was also associated with susceptibility to guilt and anxiety in women.)
4. Limb weakness, started intermittently around January - at times I feel like I've run a marathon just going up the stairs or walking to the bathroom! It comes and goes and it's too vague for me to figure out, but I am still working on the iron supplements.Can anyone think of some fun augmentation strategies for either now or the future, given these symptoms, or just in general, when I've titrated up to something more like 90mg of the Parnate? I know that I've seen some interesting ones with Parnate but you'd need a good doctor to approve them. I really want to get serious with my doc this time and leave no stone unturned...I am seriously at the end of my options here, if this doesn't work :( Thanks for your help! <3
Posted by Phillipa on May 28, 2012, at 10:12:56
In reply to Getting serious with my new doctor - what to ask, posted by violetdream on May 28, 2012, at 4:43:58
Follow up on thyroid with endo. Phillipa
Posted by violetdream on May 28, 2012, at 12:14:43
In reply to Re: Getting serious with my new doctor - what to ask » violetdream, posted by Phillipa on May 28, 2012, at 10:12:56
Good to see I'm somewhere on the right track, thanks :)
I'll have to tell everyone I told you so if I end up killing a zombie cat parasite in my brain, though!
Posted by papillon2 on May 29, 2012, at 3:10:53
In reply to Getting serious with my new doctor - what to ask, posted by violetdream on May 28, 2012, at 4:43:58
Apart from the tests you've already had:
- Endocrinologist re. hormone levels and possible PCOS diagnosis
- Sleep doctor to rule out a sleep disorder (may involve having a sleep study done)
- I assume you have had your folate level checked in your blood panel.
- Imunologist to rule out an auto-immune condition.
- Allergy doctor if you have bad allergies which worsen your depression.
- I've read about some people on the autism spectrum having success mood-wise from dietary modification. Gluten and casein seem to be issues in some people. This is a severe case, but take a look at this series of posts on Psych Central: http://blogs.psychcentral.com/therapy-soup/2011/10/autism-schizophrenia-and-nutrition-a-child-thrives/Tachycardia could be anxiety related.
Posted by creepy on June 7, 2012, at 9:03:36
In reply to Getting serious with my new doctor - what to ask, posted by violetdream on May 28, 2012, at 4:43:58
I have chronic fatigue that seems to be related to my depression. Only thing that seemed to ever touch it reliably was desipramine.
Also, intense cardio seems to help a little in that regard. But I have to push it, I cant do a leisurely walk.
Some supplements have had an effect in the past too. chromium picolinate, rhodiola rosea, NAC, large doses of vitamins C and B.
If AAP's worked a bit, what about serotonin receptor antagonists like nefazodone, or vilazodone? Maybe some of the melatonin receptor drugs?
I would investigate mood stabilizers like lamictal and lithium at this point if you havent already. Then Id start thinking out of the box and looking at other drugs that affect dopamine, ach, perhaps even pain meds. Stimulants might be an option especially with OCD traits.
There is some speculation that depression is related to inflammatory processes rather than a lack of neurotransmitters.
Tried any TCA's? what were the results?
Ever had a sleep study done?
This is the end of the thread.
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