madp

The feelings and experiences you described sound like a genuine "Major Depressive Episode." Most people who ask for help with depression only experience mild- to moderate-severity depression. Few people understand what true Major Depression is all about. It sounds like you do, and I'm glad that you're feeling better.

There are a couple of meds that are relatively new that have shown promising efficacy in depression: Lamictal (a GABA-ergic agent), and Seroquel (an atypical antipsychotic). Many docs are learning to use these adjunctively with SSRI's in an effort to get better efficacy with true Major Depression.

Having said that, understand that you are at continued risk for another Major Depressive episode. While you are feeling better, you have the opportunity to give structure to your life and to revamp your mental approach to life in such a way that you are better equipped to stave off future episodes. I'm not going to preach to you about how to change your attitude or outlook, but suffice it to say that one's attitude shapes and frames emotioinal experiences. It takes work, inner strength, and support, but learning how to minimize the impact of the world around us on how we feel, and taking personal responsibility for creating a life that will make us happy, are crucial skills to acquire. I hate to use a cliche', but there is nothing outside of us that will make us happy with ourselves. If we look for external sources of happiness and satisfaction, we will always be disappointed.

You have been through one hell of an illness, and I salute you for your resilience.

Unless you are passionately compelled to pursue more esoteric, narrow, and academic career paths, forget about behavioral neuroscience and neuropsychology. There are limited career opportunities with graduate degrees in these disciplines, and there is vicious competition for the opportunities that do exist. I tried out the academic life, and I found it stifling, homogenized, and somewhat divorced from reality, so I am biased on this subject.

Medical school is a decent career path. It's hard work and long hours and crippling to your social life, but it is rewarding in many ways as well.

As for the question about birth control. . . any medication that alters hormones has the potential to affect mood.

Stoicism is DEFINITELY a negative behavioral effect when triggered by a bad date, but I've never tried birth control pills before.

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Tuft

Stoicism as in emotional and mental apathy, not the philosophical movement. Emotional apathy, on a practical level can hinder decision making, and on a social and personal level can harm relationships and immediate-well-being, among other things. I would consider this a symptom of potential behavioral changes (including clinical depression) because of the presence of novel or changed hormonal levels.

I am passionately compelled, that's certain, but I am also impassioned with a love of many things that may limit my choices in various ways. I've got a lot of sorting out to do amongst my academic, occupational and social/personal life. Being twenty-something is more difficult than I would have expected.

I think it's a noble path, for sure. If I didn't pursue something concerning neuroscience and I attended medical school, I'd consider going into ob/gyn or developing health care in third world countries/parts of the US.

Might there be any preventative measures, such as changes in lifestyle or other medications, that could counter those changes? Do you have any specific knowledge on the affects of female birth control? Trends, et cetera.

madp

Tuft, it's not my area of expertise, but I do know that the implants and injectibles (Norplant and Depo-Provera, most notably) have been associated with a higher frequency of mood disturbance. Also, the pills that have a combination of both estrogen and progestin have a documented greater potential for causing depressed mood than those that contain progestin only.

With oral contraceptives, I've never had a patient complain specifically about it's affect on mood, so I haven't really had to impetus to do thorough research and consultation beyond the basics. Your ob-gyn would know more about the specifics than I do. The best I can do is suggest that an oral contraceptive containing ONLY progestin is less likely to cause or exaccerbated mood episodes than other oc's, injectibles, or implants.

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noahfor

Thanks for the reply. It may be a cliche, but hearing it said by a psychiatrist adds some power to it. Thanks.

What are your opinions on Tianeptine as a treatment for depression and anxiety?

madp

Noah, tianeptine is not FDA approved for use in the US, so it is not a medicine that US psychiatrists use except under special circumstances.

In general, it is a tricyclic antidepressant, yet does not appear to cause the same degree of cognitive disturbance, abuse potential, or disturbance in sexual functioning that other tricyclics can cause.

The efficacy data suggest that it is probably as efficacious as most SSRI's and and other tricyclics. However, there is nothing in the data that suggests it has any advantage over other agents currently available in the US. Furthermore, the manufacturer apparently doesn't believe it that it has any advantages that would allow it to make any headway in the VERY lucrative US market, and thus have not been willing to pay for FDA clinical trials.

One caviat: there is a general belief in the concept that someone's genetic coding predisposes them to be "responders" or "non-responders" to various drugs within a class. Thus, any given individual may not respond to a drug that has tremendous efficacy with the majority of patients who take it, and any given individual may respond like gangbusters to an agent that has poor efficacy for most patients who take it. In the end, the only important question is "how does it work for you?" If you are not currently on the drug, the data suggest that there are probably more promising options out there.

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abaya

As a lady (and this topic comes up OFTEN in the Ladies' Lounge and Sexuality), I have to say that in my experience, the Ring has been pretty good to me in terms of hormonal BC. I have always been a bit moody in general, but I do think that being on the Patch for a year exacerbated the problem, a bit. Once I switched to the Ring, which is supposed to have some of the lowest hormone levels available (due to its placement in the vagina, practically in the bloodstream itself!), I do think my moods calmed down *a bit*.

I have never been on oral contraceptives or anything injectible, btw, but I have heard that the injectibles really do screw up a woman's body more than any other BC. The least-affecting route (other than barrier methods) is most likely the IUD.

But this is all informal experience... probably be best to talk with an expert in the contraceptive field about that stuff.

__________________
And think not you can direct the course of Love;
for Love, if it finds you worthy, directs your course.
--Khalil Gibran

goddfather40

madp,

I have been on 20 mg of Paxil for about 5 years now due to panic disorder. I have a very hard time losing weight and keeping it off. When I started on Paxil I was around 200 lbs (I'm 6'2"), now I am around 290 lbs. I am now 26 years old and I eat a 2200 calorie diet and exercise 3 times a week. That should be enough to get me down to around 250 at least. Is the lowering of the metabolism due to the Paxil at fault for my weight difficulties? Or is it the fact that I am now 26 and getting older? Also, I would love to get off Paxil, but whenever I consider it, it seems I have a minor panic attack within a week or so of considering and I don't do it. Any insights?

Thanks

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tamiks8

My Family Doctor cannot figure out what is wrong with me, can you offer an opinion? Over the last 6 months or so I have been experiencing heart palpitations very often, and usually many in a row. These happen mostly after exersize, after eating, or sometimes when Im doing absolutely nothing. My Dr feels that panic attacks bring on the heart palpitations, but I feel that the palpitations bring on my anxiety, as they are very scary to have. I was put on Zoloft, 50 mg, which has done nothing at all, even after 6 weeks. The only things that seem to help are beta-blockers, which I dont like taking, because I cannot exersize, or even walk fast after taking them. Not to mention drink any alcohol. As a mental health Professional, do you beleive that a person with anxiety should be having so many palpitations (many per day), especially after eating and exersize?
I know you dont specialize in this field, but could a certain birth control pill (or horomone related issues) alter a persons' anxiety level to the point of panic disorder?
Thanks so much!

madp

I am out of town until late next week, and will be unable to respond in a thoughtful manner until I return.

thx,
madp

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goddfather40

Not a problem at all. Thanks for taking the time to respond and have a safe trip.

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I got ho's and I got bitches,
In C++ I branch with switches
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madp

Weight gain is not a common side effect with Paxil, and certainly not the degree to which you're talking about. And, to be completely honest, that's where my expertise ends on this subject. However, if you want to get off of Paxil, psychotherapists with expertise in cognitive-behavioral therapy have great succcess in helping people with panic disorder completely overcome the problem to the extent that they no longer require pharmacotherapy. If you life in a metropolitan area, there should be an expert or two around. However, if the therapist only "dabbles" with cognitive-behavioral therapy, it is likely to be a longer "trial and error" process.

Getting back to the weight gain. . .if you REALLY eat a 2200 calorie diet and exercise 3 times a week. . . .I'm completely baffled. Is this degree of obesity (and let's face it. . . 290 at 6'2" is dangerously obese) common in your family? Are you on any other medications? I'm afraid I don't have any insight, but I would go see an endocrinologist if your diet and exercise routines are as you describe them. That just doesn't make any sense to me, and quite frankly it doesn't sound normal.

Panic disorder can definitely cause heart palpitations, and most people who go to the ER thinking they are having a heart attack are actually suffering from a panic attack.

Having said that, there are way too many things that could be causing your palpitations for me to even give you an educated guess. I often ask people if they take any decongestants (i.e., claritan D, Allegra D, Pseudophed, etc), or drink excessive amounts of strong coffee, because all of the above cause heart palpitations like an MF. But again, there are just far too many possibilities for me to give you any kind of meaningful or reliable response. Sorry. Go to a cardiologist and get a stress test if you aren't happy with the answers you're getting from your primary care doc.

Also. . . a brief afterthought. . . Paxil is generally considered to be the SSRI of choice for people suffering from panic disorder.

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JustJess

tamiks8 - I will also re-emphasize that you should talk to a GOOD cardiologist. My mom has had a very similar-sounding history - wild heart rate jumps for seemingly no reason, as well as when trying to navigate stairs or just walk. She's older than you, I'm sure (63), but... I thought for sure it was panic attacks. But nope. She has a fantastic cardiologist who is getting to the bottom of things. A big part of her problem was that she's hypertensive (HBP), and has a weakened valve (I think the AV valve, but I'd have to confirm). Also, she has anemia - the type where she has too many RBC's, so her blood is thicker and harder to pump.

There are a lot of factors that go into these things, and you should talk to a doctor that will look at the WHOLE picture, and not just the part they're good at.

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My heart knows me better than I know myself, so I'm gonna let it do all the talkin'.

roadkill

For people with aspergers like my self, I've found that I have immense problems starting out relationships of any kind. What are some books or groups that can help alleaviate the problems of dealing with society that makes my life so stressful?

madp

Roadkill, Aspergers support groups can be found in most cities. Also, for social activities, go for things that provide structure to the interactions (e.g., volleyball/basketball leagues, continuing education classes, yoga, church groups, etc.). When the social situation has some degree of structure and mutually agreed upon purpose, most people find it much more comfortable to interact.

Beyond those common exceptions, a therapist who has experience with Aspergers syndrome would probably be able to help you put together an individualized strategy for coping and bringing the stress level down.

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roadkill

Thank you for your help.

snowy

Also, albuterol (the most common form of inhaler for asthma) can cause heart palpitations.

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If I am not better, at least I am different. --Jean-Jacques Rousseau

noahfor

Dr.,

Thanks for all your previous responses.

Do SSRIs, specifically Lexapro, have any effect on testosterone levels, muscle building, or strength gaining, or anything else related to that kind of stuff?

Also, every time I am taking an SSRI I get worried that the medication os going to "burn out" some part of my brain, or make it so that I need the medication to stimulate a certain part of my brain. Is there any reason for me to think something like this could happen?

Thanks.

Snakedance

Hey Jaded Mental Health Professional,
My ex-fiance left me about 6 months ago. We have had a relatively stable 4 year relationship. She took a one month trip and called me at the end of the month to tell me she had met the most wonderful person in the world. The conversation continued with her saying that she wouldnt be coming back home. Ever. She hasnt returned. She remains in contact with her family, but that is all. She even left her teenage kids with her exhusband, even though she had full custody. She has a history of Borderline Personality Disorder, and all that it implies. I know I should have run from her in the very beginning, but it was an intense relationship that I dont regret. How common is this behavior with BPD? What do you think is going to occur to her long term? Thanks.

__________________
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cookmo

Hi madp,

I have a question for you so here goes.

I grew up in an alcoholic/drug addicted family. Both my parents, there second, and third marriages, and numerous boyfriends and girlfriends all were raging drunks/addicts. Three of my five brothers also struggle with these same problems, and so do various aunts, uncles, and cousines.
I rarely drink, maybe twice a year, but even then it's still only light social drinking. Bieng around alcohol or even just the thought of it gives me severe anxiety. I am really actually jealous of people who can drink and have fun, because I feel I have been cheated.
Now here is the problem, every man I meet turns out to be an alcoholic. It's almost like a sick joke. And no, I am not picking them up in clubs or bars. I really try to screen them, but it seems its always hidden at first. There must be be something subconscious I am doing/looking for. I know I have a co-dependant personality, but I swear I make a conscious effort to avoid these situations.
Of course I wonder if it could just be that my image of alcohol is severly distorted?
I dont know if you can give me any advice, but I thought I would put it out there. Thanks.

SSJTWIZTA

man, when i go to sleep i dont dream.

i cant remeber the last time that ive had a dream. its something thats been bothering me for a while.

__________________
First they came for the Jews and I did not speak out because I was not a Jew.
Then they came for the communists and I did not speak out because I was not a communist.
Then they came for the trade unionists and I did not speak out because I was not a trade unionist
Then they came for me And there was no one left to speak out for me.
-Pastor Martin Niemoller

robot_parade

Thanks for doing this!

I suspect that my wife is mildly depressed - in that she seems to have more bad days than good, and that sometimes she gets in a 'funk' where nothing can cheer her up...and they seem (to my unexpert opinion) to be more serious and frequent than the normal 'blehs' that everyone gets. I should mention that both my mother and my brother suffer from depression - both of them exhibit symptoms much more severe than my wife...but I think I see the same kind (thought not at anywhere near the same level of severity) symptoms in my wife. My question is, what, if anything should I do?

A few years ago, I finally convinced my wife to see a psychologist, and, honestly, I don't think she did anything useful...she proscribed some meds (I don't remember which one at this point), and said essentially "see you in six months"....my wife said the meds didn't help, and didn't go back.

So, it continues...again, it seems to be very mild as far as the symptoms go - no suicidal tendincies, or anything like that, but...just too many 'bad days' for no good reason. I've tried of couple of times since the last Dr. that maybe she could try someone else, but she hasn't yet. I feel like if she talked to someone who actually cared and worked with her, maybe she could get some help...maybe with medication, maybe not, I don't know.

So, what do you recommend? Should I keep 'pushing' her to make an appointment, or should I back off and wait until she's ready to do it on her own? It's very frustrating to me, because *if* she does suffer from depression, it is very mild...much of the time she's just fine.

threewingedfury

Ok my husband has a lot of problems, I dont even think his psychiatrist understands him. His depression has lead him to cutting and trying to overdose a few times. He has a lot of anger issues, has been through anger management, and it didn't help.

His medicines include Wellbutrin 300 mg/day- for his depression, Trileptal-2400 mg/day for anger, Cymbalta- 60 mg/day for chronic knee pain and for premature ejaculation, Thoriazine - 50 mg as needed for anxiety, Risperdal - 4 mg at night for sleep, Fentanyl patch 50 mcg/hr- chronic knee pain. None of his medicines are really helping his depression, nor his anger, even though his fentanyl does help his knee pain (he was shot in the knee and has serious tissue damage).

He goes through a lot of mood swings and his nerves are really messed up. He shakes uncontrollably when he gets anxious, and starts to throw fits so to say. He has anxiety attacks 2-3 times weekly. His psychiatrist changes his medicines once every month or so, because nothing seems to work.

He has been on Lexapro, Seroquil, Trazadone, Paxil, Effexor, Abilify, Remeron, Neurontin, Haldol, Klonapin, Ativan, Visteril, and god knows what else. Hes immune to everything he takes, and when he does start to feel better, a month later, things get worse. I dont know if his psychiatrist is putting him on way too many meds, and something isnt working right, or if he is just going to be stuck with his problems forever. He can't work due to his problems, and has been waiting on disability for 17 months now, so we're kinda poor.

I don't know what to do. There is only one psychiatrist in the area, and everything outside of town doesnt accept our insurance. I'm kind of giving up, because I feel as if there is nothing left except to dope him up on thoriazine. Any suggestions?

SSJTWIZTA

i posted this before but the thread was cleared before i could read the responce.

i dont dream. i cant remember the last time i had a dream. it makes me think sometimes...any ideas on why?

__________________
First they came for the Jews and I did not speak out because I was not a Jew.
Then they came for the communists and I did not speak out because I was not a communist.
Then they came for the trade unionists and I did not speak out because I was not a trade unionist
Then they came for me And there was no one left to speak out for me.
-Pastor Martin Niemoller

nrclark

just when i was going to take advantage of the free advice, you go on sabatical

just kidding, hope everthing is ok.

what you are doing is "fantastic", and from reading the responses, helping lots of people ... kuddo's!

dd3953

here's my question: is there a real difference between ADHD & ADD? & do you think you can grow out of ADHD & have it become ADD?

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passthru

What is the name of the condition where a person believes they're invulnerable? Even in situations that pose immediate, obvious physical harm the person doesn't think they will be harmed. I heard the name of this some time ago, but forgot. Hopefully I've given enough information.

edit: I thought of something else. I know hallucinations of feeling bugs/insects crawling on oneself are common for people with psychosis, and I think psychopathy too. Are there other conditions or situations that could cause a person to feel this?