6 replies to this topic

[chziime]

Now, my best friend (and yes, it's actually a friend, not a ringer for myself) is starting to get a bit hopeless about her depression. She is 40 years old, bipolar and MDD. She takes Lithium, Agomelatine, Seroquel 25mg (to sleep at night), Rhodiola cycled, thyroid replacement medicine, Deplin, and does Ashtanga Yoga for an hour a day (she is very good at it!). She keeps busy and has a prestigious job which is not quite rewarding.

I don't want to feel like I'm prying and giving too many details, as I am making this post behind her back, but she still "suffers" from things such as anhedonia, meaninglessness, and lack of internet in novel activities or experience. She often puts it as an "inability to react to external stimuli," which I myself understand. She became a vegetarian a month ago, so I know she's missing out on a lot of healthy fats... she at least takes ALCAR now (Without ALA, meh). As an intellectual, she often idealizes suicide - as opposed to last year, before she turned things around, when she was ~actually~ suicidally depressed.

I've brought up several things to her to try... Deprenyl, for one, to at least "see colors brighter," but her psychiatrist says that it can induce mania - and we don't want that! I talk about psychedelics as a treatment for depression and "feeling/seeing new things," but she's scared. She has had two Ketamine infusions via her psychiatrist, which didn't have any anti-depressant effects.

I really wish I can give more information, but I think this is enough for now. She is looking into EMDR and tDCS, but I still feel like she can try other things. I would love and appreciate any specific advice, or things to look into?

Thank you so much in advance...

Edited by chziime, 06 September 2014 - 11:17 PM.

[Flex]

Nice Doc.. Didnt know that mania is worser than suicide..

Actually do the Doc know about Her Suicide intentions ?

 

Ok, at least, I need more infos about her mood to find out whether this is caused by dopamine loss or by anything else.

 

emotions = is she able to feel deep emotions or is she more (of course unintentionally) cold or other than that ?

cognition = any impairments, forgetful, if yes how severe

how is the facial expression, are there any motor anomalies i.e. shaking or rare spontaneous jerking ?

 

How does she respond to the Medicaments and supplements e.g. Rhodiola, Lithium & etc ?

When did this started, was there anything that made the depressions worser or better i.e. Alcohol or Cannabis ?

[chziime]

Thanks for the help, and of course it's a more complicated matter than I myself described. In a couple months I'll be asking the same about my own cognition

She can feel deep emotions for me and is rarely cold. She is quite logical often, but it has much to do with her professorship career as well her comfort in performing habits and chores around the house. Also, living in New York City (coming back from vacation to home in South America, etc) usually hits her mood.
She is extremely intelligent... sometimes her memory of events or details or small things isn't the best, but she is fluent in three languages and has beautiful verbal fluency.
There are no motor anomalies. She's actually very fluid while performing yoga. When walking outside, for example, she can be a bit stiff... but it all depends on the mood.

Lithium (pharmaceutical, not elemental) keeps the mania in check. Rhodiola and the herbs give a bit of energy, but sometimes some internal irritability. Agomelatine I believe helps, as a baseline. Yoga is what helps her the most, but it is acute and does not contribute to changes in desire to do new things, think more abstractly, etc.

I don't have much knowledge about what helps... that new SSRI Brintillex helped a little a few months ago, but kept her awake at night. She doesn't use cannabis or any drugs at that, but often has a glass of wine and feels very shallow drunken effects from it. She never seems to get depressed after 1-2 drinks, just dizzy and tired.

This started severely two years ago, though it was a whole life thing. Just recently, she was worrying about "not reacting to external stimuli" or "enjoying things like people, books, or films."

[Flex]

Hmm dunno.

If she reacts sensible to rhodiola then its perhaps better to avoid Selegiline since it ihibits mao for 2 weeks instead for a few hours like rhodiola.

Could she ask the Doc to perscribe her something different ? There are a few others which might be interresting like Buspar, Tianeptine or perhaps Nortriptyline.

But the inhibitory effects on the mitochonda of many antidepressants make me worry,

because afaik they could damage cells and lead to cell death

(at least it seems to me)

So better talk with the Doc about them:

http://www.ncbi.nlm....pubmed/20588251

http://www.behaviora.../content/8/1/45

 

You or she could look into chinese herbs like Chinese skullcap

but its a potent bloodthinner( afaik anticoagulant and perhaps a platelet inhibitor too),

so it would be better when asking the doctor about any interactions.

 

She could also try:

- St. johns worth, but better choose the perika/neuroplant brand or another qualitative and pharmaceutic brand.

 

- Acetyl-carnitine but better capsules than the powder. Its very acid tothe teeth ( arround 1-3 grams)

http://www.ncbi.nlm....pubmed/24607292

...Two RCTs showed its superior efficacy over PBO in dysthymic disorder, and 2 other RCTs showed that it is equally effective as fluoxetine and amisulpride in treatment of dysthymic disorder....

http://en.wikipedia.org/wiki/Dysthymia

Edited by Flex, 12 September 2014 - 01:50 PM.

[drg]

Ill just say 'Nsi 189'. If she is desparate enough and ok with the risk it appears to have very good success with depressed people though not approved as of yet .

 

Lamotrigine - mood stabilizer - particularly effective for depression (not mania) - low cognitive side effects compared to other anticonvulsants - good adjunct to lithium.

 

N-acetyl cycsteine - for mood stabilization - good research - more like a supplement than a med and should have good side effect profile - mayaswell try it imo because its fairly harmless

Edited by drg, 13 September 2014 - 03:32 AM.

[sthira]

Is she in the second series? Ask her. Maybe her love and passion for her practice are wearing down her body. If so, has she considered toning down her Ashtanga practice to one just as fulfilling but perhaps a bit less demanding? Sorry, I just made several huge assumptions -- just guessing here on an internet forum...

[Goodenough]

Uridine has been studied for bipolar disorder and found effective. So perhaps look into Uridine + DHA + Choline stack.

 

Open-Label Uridine for Treatment of Depressed Adolescents with Bipolar Disorder

http://www.ncbi.nlm....les/PMC3080753/