nom deplume

This post is a brief description of my experience with Depression and
medication. It is an unfinished story, and I suppose it will be
unfinished as long as I live, but at least the trend has been in the
right direction. Getting the trend to go in the right direction has
been anything but easy, and I'm telling the story here partly in the
hope of encouraging readers to keep trying. Perserverance pays, but it
can take a long time.

Major Depression hit me like a ton of bricks in 1996. At the beginning
of 1996, I was mentally healthy, though under a lot of strain, and
beginning to deteriorate physically for reasons that were unknown (and
I'm still not sure are known).

By the end of 1996, I had fallen off the cliff of mental health and
lay screaming on the rocks at the bottom, in more emotional pain than
I could imagine.

It felt like my mind had been shredded. That is the best description I
can give. It was a horrible feeling, composed of unbelievable
emotional pain, raging hatred, and a ghastly sensation that my mind
was being pulled into pieces. (I can't explain the feelings any better
than this. If it doesn't make sense, never mind. No matter how you
describe it, this was a bad time.) To answer the obvious questions,
no, I wasn't psychotic: I didn't see hallucinations or hear voices.
No, I didn't have Dissociative Identity Disorder; no missing time, no
mysterious activities I couldn't account for, no strange behaviors
noticed by anyone else. However, I wondered then (and wonder now) if
my condition was an officially unrecognized state residing "next door"
to DID, through which people pass when going or coming. I suspect it
was.

I knew nothing about therapists, nothing about antidepressant
medication. I'd heard the name "Prozac," and that was about it.
Sometimes I would read descriptions of Depression, but never saw
myself in them. This wasn't blindness on my part, but because the
descriptions differed in major ways from what I experienced.

- I had tremendous rage. This wasn't listed.
- I had tremendous emotional pain that wasn't
melancholia (sadness). This wasn't listed.
- I had no problems with self-esteem.
My self-image was fine.

The others? Yes, there were matches in other areas, but I kept seeing
these big discrepancies and concluding that whatever Depression was, I
didn't have it. (Now I would say that I very much DID have it, and
that the definition could stand adjustment.)

My physical health mysteriously deteriorated. I had to stop running. I
couldn't go for long walks. I had to concentrate on walking, or I
would weave back and forth. At work, I'd often keep one hand against a
wall to stabilize myself as I walked along the hall. I could feel
myself dying by inches. Based on the rate of deterioration, I
projected my death occurring in 2002 or 2003.

And through all of this, I had to work to support my family. I don't
know how I managed it. It was hell. That much I do know.

I'll spare everyone further details about my suffering. They aren't
the point.

The first improvement was in 1999, when the terrible emotional pain
and feeling of having my mind pulled apart disappeared. Why? I have no
idea. I was seeing a therapist (my fifth, by then), but there was no
obvious connection to therapy. The best explanation I can offer is
just that I'd recovered somewhat over time. (One thing that did help,
tremendously, was acupuncture. It pulled me out of the worst moods,
reliably, often twice a week at the nadir. Why? I don't know. I don't
know why it worked. I just know what happened.) However, there was so
much that was still wrong.

At the end of 1998, I was diagnosed with Hashimoto's thyroiditis. I
began thyroid hormone replacement therapy, and about six months later,
testosterone replacement therapy. The hormones had little effect,
possibly slowing my decay for about a year, but no more.

By the end of 1999 I could no longer work, and had to stop. My weight
was up, my blood pressure was up, my cholesterol was high, my energy
was very low. I lived in a constant state of deathly fatigue,
unaffected by sleep. I was badly depressed: I could feel no positive
emotions, and my mood ranged from bad to viciously bad. It was obvious
that I was dying.

I finally went to see a psychiatrist in late Dec 1999, having
exhausted other avenues. He diagnosed me with Depression, in spite of
what looked like a mismatch to me. He prescribed Wellbutrin.

The result was astonishing.

My energy zoomed up. My fatigue disappeared. My cholesterol and blood
pressure dropped back to normal levels. I lost weight. I resumed
running, getting up to 25 miles a week. My thyroid inflamation shrank.

My physical health was back, within weeks.

I was flabbergasted. So were my endocrinologist and psychiatrist,
neither of whom expected *this* set of results from Wellbutrin. Still,
the results were inarguable.

Unfortunately, Wellbutrin had no effect at all on my mood. Neither did
many other drugs I tried over the years.

Two other medications did make a big difference.

One psychiatrist I consulted for a second opinion speculated that I
had a sub-clinical seizure disorder resulting from high fevers and
meningitis I'd had as a child. He suggested trying anti-seizure meds,
such as Depakote, to see if anything useful happened. He also
suggested trying a dopamine agonist at some point, although these are
normally used for Parkinson's disease. His final major suggestion was
to try MAO inhibitors, particularly Parnate, which was supposed to be
energizing.

I tried Depakote around the end of 2000. The result was astonishing.

Depakote put a floor under my mood. It did not allow me to sink deep
into vicious depression any more. It also cured my unquenchable rage,
just made it go away. And finally, it cured my acne. (No, this is not
a joke. It really did cure my acne.)

My psychiatrist was very surprised. By now, he knew I was a tough
patient, very treatment resistant, with highly idiosyncratic reactions
to medications. Of course, he was also very pleased (as I was) at the
improvement. We learned some things: (1) Medications could make a big
difference for me, even after many failures, and (2) my reactions were
so idiosyncratic that predicting what would work was hopeless.

Unfortunately, however dramatic the improvement Depakote brought, I
still had severe anhedonia. I literally could not have a positive
emotion. I was no longer seriously depressed in the sense of having
"down" mood, but I couldn't have "up" feelings of any kind. I lived in
a weird, shallow basin.

Countless hours spent scouring the Web for alternatives yielded a
dopamine agonist almost never heard of, called Dostinex (chemical name
cabergoline). Dopamine agonists were next on my list by this time, and
I liked the idea of Dostinex because this category of meds was
notorious for causing nausea, and Dostinex was reputed to cause the
least problem with nausea. So after a failed experiment with
Amantadine, I tried Dostinex at the end of 2002.

The result was astonishing.

It felt like part of my brain that had been "turned off" for years
suddenly "turned on." I could now feel happiness, cheerfulness, etc. I
could have a good mood, not simply the absence of a bad mood. I could
feel that being alive was actually worthwhile. My libido returned.
(Dopamine agonists may generally be good for libido. I don't know this
for a fact, but there is some evidence, and my personal experience
supports the hypothesis. I get the feeling that the medical profession
is not ready to face the issue of "aphrodisiacs" yet, and is avoiding
the issue.)

So there was my triumvirate: Wellbutrin, Depakote, and Dostinex. Each
brought a profound benefit. In each case, the benefit had almost
nothing to do with the reason the medication was normally prescribed.

There is a moral to this story, and I mentioned it earlier. Don't give
up after 2, 5, even 10 different medications. Don't give up after a
few years, either. Get a second, third, fourth (I've had a sixth by
now) opinion. Each time I've gone to a different psychiatrist, I've
gotten new ideas to try. Three of these ideas panned out spectacularly
well. Don't be afraid to try unconventional medications, especially
when conventional medications aren't doing the job.

That's enough for this chapter. I'll post another chapter soon.

* * *

PS: I have tried 16 medications for my ills since 1996. The 13 that
didn't provide obvious benefits were the following:

Synthroid
Cytomel
Testosterone
St. John's Wort
Effexor
Prozac
Zyprexa
Provigil
Amantadine
Dexedrine
Ritalin
Topamax
Lamictal

--
Nom dePlume, Ph.D

Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000
=====

dfrankjazz

fantastic story! God bless and congrats!

DF

ncf_1

You are tough
You have a great attitude.

Remarkable effort. Your courage and determination set an excellent example.


Rob.