Question:
Even someone with your identical symptoms might react wildly different to
the same medication. There is no other road than trial and error (there are
some shortcuts your doctor can take, however). You need to find a way to
make seeing the doctor again enough of a priority to do so, debts or no.
Maybe he will "spot" you a visit or two?
Answer:
It's been about 12 months ince I first posted to this group, and
I told you that I suffered from an unusual type of depression.Here is a
copy of the post:
I need some help and advice.About 5 years ago I suffered from an
extremely traumatic experience.This trauma lasted for roughly 9
months.Due to the length and intensity of it I began to feel
depressed.However this depression is not of the normal variety.I mean I
did not feel any melancholia/sadness,but felt the other physical
symptoms associated with depression: Lack of energy,lack of
motivation,intense prolonged anxiety over otherwise normally trivial
worries,complete absence of sex drive,total inability to feel
emotions,such as anger and sadness, and a general inablity to feel any
physical/bodily pleasure.I think there is a name for this kind of
depression which manifests itself physically without any sadness
(I think it's called 'Dysthimia',long term,low grade depression
combined with Post traumatic stress from the traumatic events)
I have been suffering from this for roughly 5 years,even though the
original trauma is over,my brain refuses to move on.What i want advice
on is the best type/combination of anti-depressants for this type of
depression.There are so many,from Prozac to Wellbutrin to Zoloft that
I'm very confused. Finally I realizes that you were all probably right and I made an
appointment to go and see a doctor. The doctor prescribed me some
anti-depressants called 'Seroxat' (also called Paxil). After taking
them for 4 weeks they have not had much of an effect on me. Their main
effect on me was to make me extremely lethargic, to the point that I
would spent all day sitting in front of the television. The pills only
had a slight postive effect on the other sypmtoms of my depression.
I will try to keep this brief: My financial situation is disasterous,
I'm in srious debt. So right now I can't afford to book another
appointment to see the doctor.When i am able to save enough money I
will ask him to recommend another type of anti-depressant pills for me
to try. But,can anyone in this group be kind enough to tell me if they
have experienced a depression similar to mine, and what combination of
pills worked best for them. I am so worried by my financial debts that
I don't think I can afford to take the trial and error approach, until
I find some pills which work for me, because by that time I will have
no money left at all.
People who have not suffered from this type of depression are also more
than welcome to give me advice on any medicines they think might help
me, including drugs other than anti-depressants.
I'm really,really worried because the Paxil did not work, and really
need the advice.Am sorry to hear about the traumas you've faced. It's hard to say which
andidepressant would work the best. All the ssri's contain seritonin,
which works basically the same. Some have different properties for
anxiety or depression. One thing that would probably help the doctor
would be to put together a medical background of all the meds you've
been on, and the symptoms you've experienced, etc. Some tests may also
be helpful and cut down on the trial and error in the short term, such
as an mri, catscan, or eeg. On your next visit you could ask what
information would help him make an accurate diagnosis. That's not terribly unusual. You just described the majority of my life
from the age of 13-14 on... or at least the darkest times of it. It
doesn't scare me when I feel overly, unreasonably sad, or border on
insanely angry... it scares me when I feel nothing. By the time I was diagnosed I had been tested for cancer, AIDS, mono,
meningitis and a host of other possible causes... and told I was fine and
there was nothing wrong with me by three different doctors.
I was eventually diagnosed with chronic fatigue syndrome (CFS)... a
disease with all the symptoms of depression that's supposedly caused by a
virus (a virus that 80-90% of all adults have in their systems). Which, in
my opinion, is another name for depression diagnosed by a doctor that
doesn't know enough about depression to properly diagnose it. The
suggested cure was to wait six months and the symptom will eventually go
away... they didn't.
I wasn't accurately diagnosed with depression until I finally decided for
myself that that's what it was (when I was 23) and looked for a doctor
that had some experience in the matter.
I can sympathize with your situation... at least it seems like you aren't
going to have to deal with too much quackery and are already on the right
track.
As for advice... well, most of my advice you aren't going to like.
The truth of the matter is that even the most experienced doctors don't
know why some medications help with depression or why some work for some
people and do nothing for others. Effective treatment is still
unfortunately a case by case trial and error process. Treatment for
depression is just starting to enter the realm of applying understood
treatment based on physiology rather than simply observation of results
and saying "well, that seems to work, let's keep doing that".
That said, keep working with the doctors, trying different treatments and
remember there isn't a panacea. I've never found a drug that worked for
me... made me feel better without making me feel like I wasn't me. I'm a
bit of a masochist so I'd rather deal with the depression than zombify
myself (I have a reputation for being highly resistant to most drugs...
300mg of Trazodone does nothing to me... that much should knock out a
horse.)
Others with the same issues pop a pill and are right as rain (s!).
So, keep working on it.
But... things I did that helped (saved my life would be more accurate).
Let's start with the thing that's really going to piss you off (because it
did the same to me): All of your physical symptoms are in your head.
Assuming (disclaimer: I am not a doctor) you have depression it's your
mental state that's doing all these other things to you. None the less,
you need to get the physical symptoms out of the way before you can work
on the mental ones.
Back when I was diagnosed with CFS... slept all the time, felt like I
could barely lift my arms and it was a strain to move at all, found it
extremely hard to go to work... really didn't care if I got fired, kicked
out on the street, etc... just wanted to be left alone, didn't want to see
anyone or talk to anyone... pretty much just didn't care.
I read a few books on CFS, specifically one (ISBN: 0060922605) written by
two doctors, one of which was having his life ruined by the "disease", and
came across a few things that were surprisingly effective.
I'm not someone that believes in anything holistic or touchy-feely and,
quite frankly thought all this was crap... now I think it's crap that
works.
There are many stories told by the healthy doctor about his observations
of his unhealthy doctor friend and co-author that were very familiar.
Like if he could be coaxed into participating in doing something that he
could get his head into, where his concentration was focused and the rest
of the world dropped away his physical symptoms would go away... the
second he stopped doing whatever it was that had his attention the
symptoms would instantly return.
They started doing experiments with the ill doctor exercising his will...
effecting the universe around him, not because of necessity, but purely as
a show of force as it were (moving a salt shaker from one end of a table
to the other for no other reason but to do it and consciously thinking "I
am doing this because I will it to be done" while he was doing it.)
Don't laugh... I've done it, it works, it makes doing other things
easier... and it cracks you up and gives you a good laugh while you're
doing it because it's so freaking stupid!
Start small... move a cup from one place to another every half hour
today... doing the dishes next week... actually getting some exercise the
next... etc. Just remember to think consciously about why you're doing it
and that it's an expression of your will, strength and power that you're
doing it (little victories are victories none the less and you're fighting
a war against your brain... it has the advantage).
On a sad note: getting exercise is important... and it helps to cut the
majority of sugar and caffeine out of your diet.
When I get in a rut (which I'm in now btw) and notice I'm putting a dent
in the couch and have watched more TV than is humanly reasonable I still
do this to get myself going. Writing this is making me think I need to go
bat the salt shaker around tonight... or maybe get the 200 beer cans off
of my kitchen table.
This won't cure your depression obviously... but you won't be fighting it
from a disadvantage anymore... the stronger your will is the easier it is
to fight the disease and the easier it is to recognize behavior in
yourself that's symptomatic of the disease. Making your will stronger is
surprisingly easy... if not somewhat embarrassing.
Well... that was long and I hope helpful. If it didn't help you, I'd like
to thank you for helping me at least... that was cathartic. I've been in a
pretty deep dive myself for the last several months (year and a half)...
and it's about time I tried to do something about it.
I'll say exercise. (This all assumes you can physically exercise, if you can not
speak to a exercise therapist soon) At first force yourself to walk breathing deeply, then
add some short jogs. Do it everyday. If you have access to a bicycle, use
it. If you can swim, do it. Get up and do it like your very life depended
on it. That's all I'll say at this time.Since there's such a wide variety of suggestions, I'll add one more.
Sunlight is supposed to help depression and other things like how well
you sleep, so when you exercise, do it outside in the sun. And maybe
you'll feel a little better to realize that your financial problems are
temporary and when they go away that will make you feel a little better
and expedite your search for the right medication, though with time
you'll probably be able to find the best medication anyway, and it will
probably be better than this first one that you tried. Let's start here. If you are suffering from a trauma-induced disorder,
medication won't necessarily fix it. It may help in some ways, but
trauma can do strange things to your inner landscape that can't be
cured by medication (though I'll address medication below). My first recommendation would be to see a therapist who specializes in
trauma-induced disorders. Your problem may be more one of, for
example, dissociation, than depression. A good place to start would be
the International Society for the Study of Dissociation
(http://www.issd.org/), and I'm sure a Web search will turn up other
trauma-oriented organizations that can provide referrals to
specialists.
I think the term you are looking for is 'anhedonia,' which means the
inability to feel pleasure. Everything but the anxiety fits the
description, but anxiety sticks out like a sore thumb. You can treat
both anhedonia and anxiety with medication, but I'm not sure it's the
best way to go. I really advise seeking a trauma specialist. If your primary complaint is anhedonia, rather than standard
'melancholic' depression, serotonergic antidepressants aren't likely
to be of much use. Anhedonia (including lack of libido as one of the
important symptoms) is more likely to respond to dopaminergic
medications. There are not very many of these, but the ones that exist
can be quite effective. Lack of energy, as distinct from lack of motivation, can reflect
endocrine problems (e.g. thyroid, testosterone, anemia, etc.). I have
heard anecdotal evidence that emotional trauma can cause physical
damage to the thyroid gland, by inducing an auto-immune disorder
called "Hashimoto's thyroiditis." You should get your endocrine system
checked out, and see if you have Hashimoto's, hypothyroidism, and so
forth. If you do have an endocrine problem, treatment is simple, but
psychotropic medications will not compensate for it.
If endocrine problems and anhedonia are not the reason for your lack
of energy, then you may benefit from a stimulating medication, meaning
one that increases norepinephrine concentration. Increases in
norepinephrine levels boost energy and improve concentration.
So now let's look at some psychotropic medications that are relevant
for anhedonia and lack of energy.
Wellbutrin: Increases norepinephrine, mildly increases dopamine. Is
energizing, may help anhedonia.
Selegiline: Increases norepinephrine and dopamine, both strongly. Is
energizing, much more likely than Wellbutrin to alleviate anhedonia.
The caveat with Selegiline is that it is incompatible with
serotonergic medications, cough medicine, decongestants, Demerol, and
a variety of other common medications.
Strattera, Edronax: Increases norepinephrine alone. Energizing, but
not likely to help anhedonia.
Dopamine agonists: These medications (there are many in the category)
act as substitutes for dopamine. They can alleviate anhedonia and
improve libido, but will not increase energy, since they have no
effect on norepinephrine. Amantadine is probably more well-known to
psychiatrists than the others in this category, but it is also the
weakest (and I didn't notice any effect from it when I tried it).
Cabergoline is supposed to be the easiest to tolerate, meaning it has
the least side effects, but it can be expensive. It may be that almost
any medication in this category (other than Amantadine) will suffice,
if you aren't troubled by side effects.
Finally, you might want to read up on all these medications on my Web
site, where you can find more information.
