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Q: Would Lithium be of
Help to Me ?
Hello,
I have been diagnosed with Major Depression Disorder and anxiety. I was put on
Klonopin back in around 1991 for anxiety. Before that I was given Prozac after
I couldn't sleep for 2 weeks, but it made me feel horrible, so I flushed them
down the toilet. After college in1995 I moved to NYC and I had to find a new
psychiatrist to get my prescription for Klonopin. He did not like the idea that
I was treating my anxiety with monotherapy and decided I should also be put on
Zoloft. I stayed on Zoloft until 2009 when I asked myself why was I still
taking a drug that I felt was not doing anything. I went to a psychiatrist and
we tapered me off. I was ok for a few months then I crashed. I've been
wondering if going on an antidepressant in the first place has now doomed me to
be on them forever. Now I have been very depressed since October 2009. We have
tried several drugs. We have tried Cymbalta, Remeron, Vyvance, Seroquel,
Clonazepam, Adderall, Zoloft a gain, Wellbutrin XL, Abilify and Pristiq (I hope
I haven't forgotten any). All at various dosages. Right now we are trying
Effexor XR, Lovaza and Diazepam. I'm also taking N-Acetyl-LCysteine because I
have been taking for "brain zaps" I had whenever I looked to the right, I had
them for years and years. The "zaps" have actually gone away, but that could
also be because I was getting them from the Klonopin/Clonazepam which I have now
stopped taking and I am taking Diazepam instead. I have also had 14 ECT
treatments from another doctor. The problem was I was/am experiencing severe
cognitive problems and my depression didn't go away.
I have been told by others that I seem better though. My Psychiatrist decided
that the cognitive problems were too great and the pay off was not so he decided
we should stop for a few weeks and see if my memory gets better and we can
always go back to ECT, but it seems like I have leveled off and it has not
lifted my depression. I have be en very depressed and suicidal and this has
been going on for over a year and a half. There have been some mild ups and
downs, but October 2010 was terrible and I was very suicidal so that's when I
and my Psychiatrist decided to give ECT a try. He has also been thinking of
putting me on a mood stabilizer as well. I would assume something like
Lithium. I started reading Dr. Phelps' book and "Soft" bipolar disorder seems
like it might make some sense since I have taken so many medications and my
depression become worse towards the end of 2010 and I stopped Zoloft in 2009,
but I am just so frustrated and hopeless. I think about death every day.
Regards,
Mr. C
Mr. C,
Thanks for writing and
for the questions. The idea of "soft' bipolar illness does seem like a
possibility but you and your psychiatrist should review your history for any
epiodoes of hypomania to distinguish between the diagnosis of bipolar illness
and treatment refractory depression. Sometimes it can be difficult to
determine however. I would agree that Lithium would be the next choice
expecially since the ECT doesn't seem to have helped you very much. Depakote
is another possibility as well, and you and your psychiatrist may want to
consider the tricyclic antidepressants or MAOI's if you determine that this is
a treatment refractory depression rather than bipolar illness. I would also
recommend some sort of psychotherapy or intensive outpatient program for you.
Dr Plyler
Add-on note from Dr. Plyler:
I
think that the combination of Effexor XR and the Lamictal is a good choice,
and I would continue the work with your therapist. Refractory or treatment
resistant depression is defined as depression not responding to adequate
courses of at least two antidepressants. Your environment can have a
significant effect on your mood, so working on lifestyle changes may also be
useful.
Dr
Plyler
Published in May, 2011
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