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Suggest Treatment For Major Depression Despite Taking Wellbutrin And Lamotrigine
Question: I am a female, 68, and have struggled with major depression for most of my life. I have already tried most of the available drugs. Prozac, which was always my favorite, now causes significant hearing loss, so I've had to discontinue it. Weight gain is totally unacceptable to me, as I'm pre-diabetic and find weight gain to be unacceptably demoralizing. I am additionally taking Wellbutrin (max dose) and lamotrigine (max dose). Please suggest new approaches and meds I might take. I've never had ECT. What is your opinion of this for me? Also, can you recommend a top quality psychiatrist in Johnstown, PA or nearby? I don't get enough time or attention from the one I currently have. Fifteen minutes per month is simply insufficient.
Thanks a lot for your YYYY@YYYY
Thanks a lot for your YYYY@YYYY
Brief Answer:
Pristiq could be a option
Detailed Answer:
Hello,
Thanks for using Heralthcaremagic.
I read your query and understand your concerns.
First regarding treatment I feel rather than a single medicine, two medicine will be better. Considering the borderline personality with somewhat resistant depression I feel combination of pristiq along with abilify could be a best option. The points in favor of this combination is obvious as it have least tendency to cause weight gain. In addition the possibility of diabetes remains either same or decreases with use of these two medications, in particular ability.
I must acknowledge that the dose is domain of treating psychiatrist but in my view 50 mg of pristiq with 5 mg of ability could do a trick. For this dose there is no titration required and can be started from day one.
There is no doubt that ECT is most effective and most safe treatment for depression and can be used if the medication are not helpful. This is not the first line as lot of stigma is associated with use of ECT.
Regarding a psychiatrist in Johnstown I am unable to help you.
I hope this helps you.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
Pristiq could be a option
Detailed Answer:
Hello,
Thanks for using Heralthcaremagic.
I read your query and understand your concerns.
First regarding treatment I feel rather than a single medicine, two medicine will be better. Considering the borderline personality with somewhat resistant depression I feel combination of pristiq along with abilify could be a best option. The points in favor of this combination is obvious as it have least tendency to cause weight gain. In addition the possibility of diabetes remains either same or decreases with use of these two medications, in particular ability.
I must acknowledge that the dose is domain of treating psychiatrist but in my view 50 mg of pristiq with 5 mg of ability could do a trick. For this dose there is no titration required and can be started from day one.
There is no doubt that ECT is most effective and most safe treatment for depression and can be used if the medication are not helpful. This is not the first line as lot of stigma is associated with use of ECT.
Regarding a psychiatrist in Johnstown I am unable to help you.
I hope this helps you.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. XXXXXXX
The issue with Pristiq is that it is very similar to Effexor, which I took for nine years
until it stopped working 11 years ago. The withdrawal from this drug was nothing short of hellish. Why would Pristiq be okay if Effexor stopped working? What about the frightening ultimate withdrawal from it? Also, at the time the Effexor stopped working, it also caused my blood sugar to skyrocket to 304. After discontinuing it completely, my blood sugar dropped back into an acceptable range. That's certainly very scary! To repeat, the withdrawal from Effexor was hellish. This period of becoming tolerant to the med. and needing to switch was some of the worst depression I have ever known.
My doctor had proposed Abilify years ago. I rejected this option because it has a substantial tendency to push people over into full-blown diabetes, and is associated with alarming weight gain. Either or both side effects would be unendurable to me. So instead, the doctor put me on buspirone, and I worked up to 60mg. total per day. He said this is good for treatment-resistant depression, to bolster the Prozac that had become ineffective. I am now taking lamotrigine (400 mg. per day), Wellbutrin (450 mg. per day), sertraline (100 mg. per day), and liothyronine (50 mcg. per day). I stopped the busprione because I didn't think it was doing all that much. Do you think I should resume it? I stopped the Prozac (generic fluoxetine) because it was causing hearing loss, and this terrified me. Since stopping it, my hearing has returned to normal.
Additionally, if you could show me how to cope much better with chronic, substantial borderline psychic pain, it would be invaluable. I am of the borderline type that turns the pain and anger inward upon myself. I am highly educated, ladylike, and passive rather than aggressive. Although I know borderlines are widely despised due to their aggressiveness, I am not like that at all. Over the course of my lifetime, I was generally the victim of maltreatment rather than the perpetrator of it. So I don't deserve (at all) the contempt that is often directed at borderlines. Seventy per cent of borderline women were the recipient of serious abuse, and I fit that category. I experienced verbal and physical abuse, but thankfully not sexual.
Thanks for your concern, empathy, and input.
XXXXXX
The issue with Pristiq is that it is very similar to Effexor, which I took for nine years
until it stopped working 11 years ago. The withdrawal from this drug was nothing short of hellish. Why would Pristiq be okay if Effexor stopped working? What about the frightening ultimate withdrawal from it? Also, at the time the Effexor stopped working, it also caused my blood sugar to skyrocket to 304. After discontinuing it completely, my blood sugar dropped back into an acceptable range. That's certainly very scary! To repeat, the withdrawal from Effexor was hellish. This period of becoming tolerant to the med. and needing to switch was some of the worst depression I have ever known.
My doctor had proposed Abilify years ago. I rejected this option because it has a substantial tendency to push people over into full-blown diabetes, and is associated with alarming weight gain. Either or both side effects would be unendurable to me. So instead, the doctor put me on buspirone, and I worked up to 60mg. total per day. He said this is good for treatment-resistant depression, to bolster the Prozac that had become ineffective. I am now taking lamotrigine (400 mg. per day), Wellbutrin (450 mg. per day), sertraline (100 mg. per day), and liothyronine (50 mcg. per day). I stopped the busprione because I didn't think it was doing all that much. Do you think I should resume it? I stopped the Prozac (generic fluoxetine) because it was causing hearing loss, and this terrified me. Since stopping it, my hearing has returned to normal.
Additionally, if you could show me how to cope much better with chronic, substantial borderline psychic pain, it would be invaluable. I am of the borderline type that turns the pain and anger inward upon myself. I am highly educated, ladylike, and passive rather than aggressive. Although I know borderlines are widely despised due to their aggressiveness, I am not like that at all. Over the course of my lifetime, I was generally the victim of maltreatment rather than the perpetrator of it. So I don't deserve (at all) the contempt that is often directed at borderlines. Seventy per cent of borderline women were the recipient of serious abuse, and I fit that category. I experienced verbal and physical abuse, but thankfully not sexual.
Thanks for your concern, empathy, and input.
XXXXXX
Brief Answer:
I think it is better if you can reconsider your decision
Detailed Answer:
Dear XXXXX,
Thanks for reverting back to me.
I understand your input and totally agree with the experience you received as I have witnessed same on many occasions.
Regarding the treatment choices I have my reservations and experiences and do not agree completely with you.
First regarding effexor and pristiq, in my experience they are completely different when it comes to response. I understand you have negative experience with effexor it does not mean the same will be repeated with pristiq. To be XXXXXXX Pristine is my first choice among the post menopausal women and find very useful in majority. Although I agree with withdrawal effects as it has not a great half life and may cause withdrawal symptoms.
Regarding Abilify in my view it is the safest antipsychotic which is weight neutral and do not cause major changes in blood glucose. I think you need to review literature about causing full blown diabetes by ability. I agree there are isolated case reports but it is largely safe.
Regarding Buspar there is no doubt that it is used for augmentation of antidepressant and helps in resistant depression. However I doubt the utility in your case as you are already taking two medications which augment/treat the treatment resistant depression which includes lamotrigine and leothyronine.
Strategies to cope with psychic pain is part of larger treatment process and I do not think it is possible for me to outline anything at this stage.
I hope this helps you further.
Thanks and regards
I think it is better if you can reconsider your decision
Detailed Answer:
Dear XXXXX,
Thanks for reverting back to me.
I understand your input and totally agree with the experience you received as I have witnessed same on many occasions.
Regarding the treatment choices I have my reservations and experiences and do not agree completely with you.
First regarding effexor and pristiq, in my experience they are completely different when it comes to response. I understand you have negative experience with effexor it does not mean the same will be repeated with pristiq. To be XXXXXXX Pristine is my first choice among the post menopausal women and find very useful in majority. Although I agree with withdrawal effects as it has not a great half life and may cause withdrawal symptoms.
Regarding Abilify in my view it is the safest antipsychotic which is weight neutral and do not cause major changes in blood glucose. I think you need to review literature about causing full blown diabetes by ability. I agree there are isolated case reports but it is largely safe.
Regarding Buspar there is no doubt that it is used for augmentation of antidepressant and helps in resistant depression. However I doubt the utility in your case as you are already taking two medications which augment/treat the treatment resistant depression which includes lamotrigine and leothyronine.
Strategies to cope with psychic pain is part of larger treatment process and I do not think it is possible for me to outline anything at this stage.
I hope this helps you further.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello. Since your last email, I have spent several hours studying anti-depressants and their side effects on the internet. It is astounding and alarming the incidence of significant weight gain in supposedly "weight neutral" meds. I read case after alarming case in the blogs. I simply couldn't bear that. I have a history of an eating disorder that I forgot to mention, and it caused my only hospitalization at age 20.
So here is my question: What do you think of Brintellix, especially given my profile and in combination with the meds I am currently taking. Is it compatible with these other meds? What impact would it have on my overall diagnostic profile? What is the impact of Brintellix on weight in female patients?
However much you are willing to tell me will be greatly appreciated. After all, knowledge is power. You are probably less than thrilled with the scope/length of my inquiries, but I am desperate for competent, comprehensive, detailed psychiatric help.
Thank you!
So here is my question: What do you think of Brintellix, especially given my profile and in combination with the meds I am currently taking. Is it compatible with these other meds? What impact would it have on my overall diagnostic profile? What is the impact of Brintellix on weight in female patients?
However much you are willing to tell me will be greatly appreciated. After all, knowledge is power. You are probably less than thrilled with the scope/length of my inquiries, but I am desperate for competent, comprehensive, detailed psychiatric help.
Thank you!
Brief Answer:
Please read below
Detailed Answer:
Dear XXXXX,
Thanks for reverting back to me.
Before I proceed with my answer I like to acknowledge that Brintellix is not available in my country of practice and I have little practical knowledge of myself using it.
Now regarding your post you are right in saying that blogs are crowded with lot of horror stories but most of the blogs have unsubstantiated data and there is no check who writes what. The so called weight neutral antidepressants have weight gain issue in small percentage but it is not possible to know what cause it for a lay person. For example a person having hypothyroidism and simultaneously he/she takes weight neutral antidepressant. In this scenario she may develop weight gain most probably due to hypothyroidism and the medication gets blame. So researching your medication is good practice but it is also important to check with official website of medication along with government websites (such as FDA).
Now regarding Brintellix, there is clear data that it is weight neutral but chances of mood swings are much higher in compare to other SSRIs and for a person with borderline personalty disorder I do not think it could be a first choice. In addition Brintellix has not been evaluated in the XXXXXXX citizens and that makes me sceptical of using it for you.
I hope this helps you further.
Thanks and regards.
Please read below
Detailed Answer:
Dear XXXXX,
Thanks for reverting back to me.
Before I proceed with my answer I like to acknowledge that Brintellix is not available in my country of practice and I have little practical knowledge of myself using it.
Now regarding your post you are right in saying that blogs are crowded with lot of horror stories but most of the blogs have unsubstantiated data and there is no check who writes what. The so called weight neutral antidepressants have weight gain issue in small percentage but it is not possible to know what cause it for a lay person. For example a person having hypothyroidism and simultaneously he/she takes weight neutral antidepressant. In this scenario she may develop weight gain most probably due to hypothyroidism and the medication gets blame. So researching your medication is good practice but it is also important to check with official website of medication along with government websites (such as FDA).
Now regarding Brintellix, there is clear data that it is weight neutral but chances of mood swings are much higher in compare to other SSRIs and for a person with borderline personalty disorder I do not think it could be a first choice. In addition Brintellix has not been evaluated in the XXXXXXX citizens and that makes me sceptical of using it for you.
I hope this helps you further.
Thanks and regards.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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