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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Barker on June 1, 2000, at 17:44:05
Hi - I very suddenly started experiencing depression along with other menopausal symptoms 3 year ago. It has since varied from mild to quite intense. Problem has been that everything I try has the same side effect within days to a couple of weeks - agitation, sometimes intense, often accompanied by a feeling of being extremely hot/feverish (quite different from hot flashes) and frequently with baseless mental/emotional anxiety. Estrogen does this - more intense in direct relationship to the dosage. St. John's Wort resulted in agitation, Zoloft in severe agitation and heat sensation (of course I was also taking St John's Wort and Estrogen when I tried it - with my then Doctor's knowledge). Phenylalanine also caused a similar reaction. I am fearful of trying new things. I have even weaned off estrogen with the result that the anxiety has decreased markedly -- however the depression has become more intense as I weaned off and is now essentially constant. Not to mention that other menopausal symptoms have returned, including night sweats. What does one do when antidepressant substances result in intolerable agitation? Is this common? It seems to point out to me that the cause of my depression is not related to a lack of serotonin, and that antidepressant substances, even estrogen (which I have read does potentiate the effect of anti-depressants) are over-increasing serotonin action in my brain?
Barker
Posted by Lurker on June 1, 2000, at 20:58:10
In reply to Same side effect to everything I try - agitation, posted by Barker on June 1, 2000, at 17:44:05
Hi Barker: My mom went through the same thing when her menopause started. She couldn't take HRT or anything synthetic. She is very sensitive to all meds, even aspirin. She saw a naturopath who told her to take evening primrose oil and eat lots of soy products. The soy has natural plant estrogens that the body can tolerate easily and the evening primrose oil is full of the same plus the B vitamins that menopausal women need. She is greatly improved now and on no meds at all. Hope this helps, keep in touch--Lurker
> Hi - I very suddenly started experiencing depression along with other menopausal symptoms 3 year ago. It has since varied from mild to quite intense. Problem has been that everything I try has the same side effect within days to a couple of weeks - agitation, sometimes intense, often accompanied by a feeling of being extremely hot/feverish (quite different from hot flashes) and frequently with baseless mental/emotional anxiety. Estrogen does this - more intense in direct relationship to the dosage. St. John's Wort resulted in agitation, Zoloft in severe agitation and heat sensation (of course I was also taking St John's Wort and Estrogen when I tried it - with my then Doctor's knowledge). Phenylalanine also caused a similar reaction. I am fearful of trying new things. I have even weaned off estrogen with the result that the anxiety has decreased markedly -- however the depression has become more intense as I weaned off and is now essentially constant. Not to mention that other menopausal symptoms have returned, including night sweats. What does one do when antidepressant substances result in intolerable agitation? Is this common? It seems to point out to me that the cause of my depression is not related to a lack of serotonin, and that antidepressant substances, even estrogen (which I have read does potentiate the effect of anti-depressants) are over-increasing serotonin action in my brain?
>
> Barker
Posted by JohnL on June 2, 2000, at 4:21:47
In reply to Same side effect to everything I try - agitation, posted by Barker on June 1, 2000, at 17:44:05
> Hi - I very suddenly started experiencing depression along with other menopausal symptoms 3 year ago. It has since varied from mild to quite intense. Problem has been that everything I try has the same side effect within days to a couple of weeks - agitation, sometimes intense, often accompanied by a feeling of being extremely hot/feverish (quite different from hot flashes) and frequently with baseless mental/emotional anxiety. Estrogen does this - more intense in direct relationship to the dosage. St. John's Wort resulted in agitation, Zoloft in severe agitation and heat sensation (of course I was also taking St John's Wort and Estrogen when I tried it - with my then Doctor's knowledge). Phenylalanine also caused a similar reaction. I am fearful of trying new things. I have even weaned off estrogen with the result that the anxiety has decreased markedly -- however the depression has become more intense as I weaned off and is now essentially constant. Not to mention that other menopausal symptoms have returned, including night sweats. What does one do when antidepressant substances result in intolerable agitation? Is this common? It seems to point out to me that the cause of my depression is not related to a lack of serotonin, and that antidepressant substances, even estrogen (which I have read does potentiate the effect of anti-depressants) are over-increasing serotonin action in my brain?
>
> Barker
Wow, that is frustrating. I sure feel for you. I know the despair you're feeling. But try to hang in there. You seem strong-willed. There is a way.Though it's probably too obvious to even mention, I think in your case it is very important to have a physician who is especially good. Not just any garden variety physican who throws SSRIs at depression patients. Do you have a real good doctor? If not, would you consider asking around for one?
Even though you've had bad experiences with meds so far, there is a bright side. That is, our reactions to different meds provide powerful clues as to what is going on. We need to know what chemistry we're dealing with, and our reactions--good, neutral, or bad--provide clues. It's kind of like detective work. I think you are already doing a great job of analyzing the clues, because you have come to question a serotonin link. That could very well be true with you.
Depression can be caused by low serotonin, low norepinephrine, low dopamine....BUT it can also be caused by excess norepinephrine function or excess dopamine function. That is even more valid when there is an anxiety/agitation component to the depression, as in your case.
You might want to ask your doc for a trial of Zyprexa, an antipsychotic. I prefer to call it a dopamine reducer. Based on the clues given so far, that would make sense to me.
Another avenue to consider would be a trial of a benzo like Xanax. Sometimes GABA malfunction is the cause of depression, and also has the anxiety/agitation component. Xanax has proven to be successful in selected patients in controlled studies as monotherapy for treating depression.
An outside possibility would be that you would respond well to a beta-blocker (antihypertensive med), or as I prefer to call them, norepinephrine reducers. But this would be farther down my priority list. Benzos and APS would be at the top of the list. I wouldn't even consider other antidepressants at this time. We can always return to them later if needed. But for now, we need more clues from other med classes to get a clearer picture. And hopefully the search will end soon as you stumble onto the right med. It's my guess, based on what you've said so far, that your best chance of finding the right med is by looking at the benzo or AP classes of meds.
But I would be negligent by not mentioning Lithium, Neurontin, or Lamictal. It could be there's a chemical/electrical instability going on here. Of the three, Neurontin in my mind would have the best chance with you, in light of the agitation component.
There are certainly plenty of choices. I get the gut instinct your answer won't be found in the antidepressant class. If you are knowledgable enough and confident enough, TELL your doctor what you want to try and why (AP, benzo, whatever). Don't ask or suggest, but rather tell him/her directly this is what you want to do. Unless the physcian is mired in his/her own ego, I have found they are usually open to complying with the patient's desires, especially if the patient has apparently put some research into the decision. You've certainly come to the right place to get started on that.
Anyway, I know there's a lot here to think about, but I hope some of it will be immediately helpful to you.
JohnL
Posted by Barker on June 2, 2000, at 7:17:47
In reply to Re: Same side effect to everything I try - agitation, posted by JohnL on June 2, 2000, at 4:21:47
> Though it's probably too obvious to even mention, I think in your case it is very important to have a physician who is especially good. Not just any garden variety physican who throws SSRIs at depression patients. Do you have a real good doctor? If not, would you consider asking around for one?Not easy - doctor shortage in the region I live in (in Canada) - both GP's and specialists. Few GP's are taking new patients, waiting lists for specialists are long.
> Depression can be caused by low serotonin, low norepinephrine, low dopamine....BUT it can also be caused by excess norepinephrine function or excess dopamine function. That is even more valid when there is an anxiety/agitation component to the depression, as in your case.
The anxiety/agitation component only really comes into play when I actually take anything to try to relieve the depression. Right now, I'm just depressed, no intense anxiety. But all the things I mentioned trying for depression relief resulted in either agitation (sensation with a large "physical" component for lack of better words) or anxiety (where the emotional component predominated). The "heavy" feeling of depression would sometimes ease (or get covered up?) while taking some of these things although it would continue to recurr in "swings", plus an element of "over-emotionality" also was instigated by many of these substances - again in direct relationship to dosage.
I am really reluctant to play around with more chemistry-altering substances, not knowing exactly what is going on inside, or why, or if things might just adjust themselves one day if left alone. Something caused this depression to appear out of the blue, there's got to be a way to make it disappear the same way.
> Another avenue to consider would be a trial of a benzo like Xanax. Sometimes GABA malfunction is the cause of depression, and also has the anxiety/agitation component. Xanax has proven to be successful in selected patients in controlled studies as monotherapy for treating depression.Interesting - I was prescribed benzos during the "anxiety" phases and quickly noticed that they do have a marked anti-depressant effect on me - which, unfortunately, wears off at the same rate as the benzo. However, I was once prescribed Xanax many years ago during a period of job/marriage stress -- and had much problem stopping due to withdrawal effects. I just don't like what I perceive as "permanent" treatments - I still think this might go away one day and I'll feel like my old self. Don't want to have developed an addiction or habit that precludes this. But - I do continue to take occasional benzos when I "need" help to function properly.
I thank you for your food for thought. Gaining insights into what is going on does help to cope with this.
Barker.
Posted by glenn on June 2, 2000, at 12:48:43
In reply to Same side effect to everything I try - agitation, posted by Barker on June 1, 2000, at 17:44:05
> Hi - I very suddenly started experiencing depression along with other menopausal symptoms 3 year ago. It has since varied from mild to quite intense. Problem has been that everything I try has the same side effect within days to a couple of weeks - agitation, sometimes intense, often accompanied by a feeling of being extremely hot/feverish (quite different from hot flashes) and frequently with baseless mental/emotional anxiety. Estrogen does this - more intense in direct relationship to the dosage. St. John's Wort resulted in agitation, Zoloft in severe agitation and heat sensation (of course I was also taking St John's Wort and Estrogen when I tried it - with my then Doctor's knowledge). Phenylalanine also caused a similar reaction. I am fearful of trying new things. I have even weaned off estrogen with the result that the anxiety has decreased markedly -- however the depression has become more intense as I weaned off and is now essentially constant. Not to mention that other menopausal symptoms have returned, including night sweats. What does one do when antidepressant substances result in intolerable agitation? Is this common? It seems to point out to me that the cause of my depression is not related to a lack of serotonin, and that antidepressant substances, even estrogen (which I have read does potentiate the effect of anti-depressants) are over-increasing serotonin action in my brain?
>
> Barker
-i have a very similar response, even to same which i am currently trying, the only meds which didnt do this for me were remeron and dothiepin, however they didnt do anything else either, i think johnl may be right and a gaba med might be worth a try, if you are not kenn on benzos then gabitril and topamax may be worth trying, seems like i may have to go this way after i try amisulpride
good luck , i like john ls approach, as he says it gives hope!
all the best
glenn
Posted by Tina1 on June 2, 2000, at 15:46:22
In reply to Re: Same side effect to everything I try - agitation, posted by JohnL on June 2, 2000, at 4:21:47
Hi Barker: You may also be a "low-dose" responder. Maybe you have to start lower and slower than what's considered the normal initial dose. It's that way with me. If the books say 10mgs I have to start on say 2-5 and work up from there. Just a thought.
> > Hi - I very suddenly started experiencing depression along with other menopausal symptoms 3 year ago. It has since varied from mild to quite intense. Problem has been that everything I try has the same side effect within days to a couple of weeks - agitation, sometimes intense, often accompanied by a feeling of being extremely hot/feverish (quite different from hot flashes) and frequently with baseless mental/emotional anxiety. Estrogen does this - more intense in direct relationship to the dosage. St. John's Wort resulted in agitation, Zoloft in severe agitation and heat sensation (of course I was also taking St John's Wort and Estrogen when I tried it - with my then Doctor's knowledge). Phenylalanine also caused a similar reaction. I am fearful of trying new things. I have even weaned off estrogen with the result that the anxiety has decreased markedly -- however the depression has become more intense as I weaned off and is now essentially constant. Not to mention that other menopausal symptoms have returned, including night sweats. What does one do when antidepressant substances result in intolerable agitation? Is this common? It seems to point out to me that the cause of my depression is not related to a lack of serotonin, and that antidepressant substances, even estrogen (which I have read does potentiate the effect of anti-depressants) are over-increasing serotonin action in my brain?
> >
> > Barker
>
>
> Wow, that is frustrating. I sure feel for you. I know the despair you're feeling. But try to hang in there. You seem strong-willed. There is a way.
>
> Though it's probably too obvious to even mention, I think in your case it is very important to have a physician who is especially good. Not just any garden variety physican who throws SSRIs at depression patients. Do you have a real good doctor? If not, would you consider asking around for one?
>
> Even though you've had bad experiences with meds so far, there is a bright side. That is, our reactions to different meds provide powerful clues as to what is going on. We need to know what chemistry we're dealing with, and our reactions--good, neutral, or bad--provide clues. It's kind of like detective work. I think you are already doing a great job of analyzing the clues, because you have come to question a serotonin link. That could very well be true with you.
>
> Depression can be caused by low serotonin, low norepinephrine, low dopamine....BUT it can also be caused by excess norepinephrine function or excess dopamine function. That is even more valid when there is an anxiety/agitation component to the depression, as in your case.
>
> You might want to ask your doc for a trial of Zyprexa, an antipsychotic. I prefer to call it a dopamine reducer. Based on the clues given so far, that would make sense to me.
>
> Another avenue to consider would be a trial of a benzo like Xanax. Sometimes GABA malfunction is the cause of depression, and also has the anxiety/agitation component. Xanax has proven to be successful in selected patients in controlled studies as monotherapy for treating depression.
>
> An outside possibility would be that you would respond well to a beta-blocker (antihypertensive med), or as I prefer to call them, norepinephrine reducers. But this would be farther down my priority list. Benzos and APS would be at the top of the list. I wouldn't even consider other antidepressants at this time. We can always return to them later if needed. But for now, we need more clues from other med classes to get a clearer picture. And hopefully the search will end soon as you stumble onto the right med. It's my guess, based on what you've said so far, that your best chance of finding the right med is by looking at the benzo or AP classes of meds.
>
> But I would be negligent by not mentioning Lithium, Neurontin, or Lamictal. It could be there's a chemical/electrical instability going on here. Of the three, Neurontin in my mind would have the best chance with you, in light of the agitation component.
>
> There are certainly plenty of choices. I get the gut instinct your answer won't be found in the antidepressant class. If you are knowledgable enough and confident enough, TELL your doctor what you want to try and why (AP, benzo, whatever). Don't ask or suggest, but rather tell him/her directly this is what you want to do. Unless the physcian is mired in his/her own ego, I have found they are usually open to complying with the patient's desires, especially if the patient has apparently put some research into the decision. You've certainly come to the right place to get started on that.
>
> Anyway, I know there's a lot here to think about, but I hope some of it will be immediately helpful to you.
> JohnL
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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