Q: What are My Options
Dear Dr. Phelps, I am 43. I have been diagnosed with Major Depression-Psychotic
features since I was 20. I think I was depressed/agitated/hypmanic since I was
5 years old at least. My latest psychiatrist thinks I'm bipolar, but my
drug sensitivites are really limiting us. Developed very bad
diarrhea with neurontin. Almost can't eat at all now. Losing weight. He's now
backed me off from 2000 to 1200 mg a day. He has me on 100mg of lamictal,
though I don't quite understand that since it is so far below what i
understand is the theurapeutic dose. I am very depressed right now. Crying all
the time, feeling terrible remorse and failure over my life, having
thoughts/impulses to suicide. My psychiatrist wants to add Welbutrin for the
depression. I have had bad reactions to every antidepressant i was ever on,
overstimulating, made voices louder, etc. , except maybe the tricyclics,
though they stopped working after a while 20 years ago. I've been through
anti-psychotic hell with zyprexa, gained 70 pounds in 3 months...a nightmare
to lose the weight...had to go on a starvation diet...took 6 months...anyway,
the first time i was on zyprexa it seemed to help a great deal for a few
months. The 2nd time i went on it the neurological symptoms were terrible, i
was shaking and spasming in my mouth...I was very afraid of tardive, so we
changed to risperdal which just made my muscles freeze and i could barely
move...it was a nightmare...i'm off that now...
So what hope is there now for me ? I have become quite discouraged. I feel
trapped with my current psychiatrist because of disability paperwork which he
started and i know the lack of continuity might weaken my case. I can't work.
I can barely think to write this note. Any advice would be so welcome.
Also are there any referrals you could
make for experts in mood disorders in chicago metro area ? I'm thinking
i should at least get a 2nd opinion. Or maybe we just have hit the wall in
terms of options for me. I have to take a lot of ativan each day just to keep
myself from becoming hysterically upset, so the depression is definitely quite
Forgot to mention, I have both Grave's disease and Hashimoto's syndrome,
so my thyroid is a trashed...had Grave's since I was 20...
Thanks for your thoughts. C...
Dear Ms C. (or put it this way: I'd be quite
surprised if it's Mr. C)
In general, the strategy I'd pursue -- for you to discuss with your doc' -- is
combinations of every mood stabilizer you can tolerate; rigorously avoiding
antidepressants; and a trial of T3/T4 thyroid replacement if you aren't
already on that. I've only had a handful, say less than 5 out of many
hundreds of patients who have not been able to get stable using this approach;
then we've turned to ECT (successfully in two). Take a look at all the
medications the NIMH tries, in combination, for people like you, in one
example on my site. And if it is indeed Ms. C, as opposed to Mr. C, then
there may be a role in treatment for hormones somehow; we're just beginning to
recognize that and so far the only strategy I've seen, with not too striking
results, is to stop hormonal cycling, usually by giving estrogen and
progesterone together, in a steady dose; lot's more to learn there.
of mood stabilizers I use is on my site. As for doc's in Chicago,
route. My experience so far trying to figure out the role of thyroid in
this story, which I'm sure is related somehow, will be updated regularly in this
section of my site. That my be a very important part of your
treatment; at least I'd have some significant hope in that direction -- but
I'd be encouraging you not to share that hope too much until you see what
happens (it doesn't take but a few days for those for whom it works).
I'm just hoping you're not taking T3/T4 already. Good luck out
Published September, 2001