Would Lithium be of Help to Me ?
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Q:  Would Lithium be of Help to Me ?


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.
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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