[rliz]

I am a 52-year-old female who has suffered from a mood disorder (major depressive disorder and possibly BPII) since the age of 12, although I was not treated until a major episode of depression that was triggered by Aldomet at the age of 17. I have been on every antidepressant and some mood stabilizers with varying success. Some medications helped a lot until "poop out". Despite numerous hospitalizations, I was able to pursue a career in IT until 2002. At that time I developed cognitive difficulties and neurological symptoms (including episodic ataxia and other stroke-like symptoms) that were attributed to complicated migraines and/or TIAs. Hormonal issues, anemia and mild hypothyroidism probably contributed to a return of depressive symptoms (alternating with short episodes of hypomania) once my neurological symptoms finally abated on a gluten-free diet that I've been on since 2004.

I have had several courses of ECT which probably saved my life because I was acutely suicidal. My last treatment was in April 2005 when an episode of atrial fibrillation failed to resolve itself (as it had done once before) following my treatment. Two medications were administered and I was told that a cardiology consult would be required before any further ECT could be administered. After a year of asking about the cardiology consult, I gave up and decided that ECT was no longer an option for me. Since that time, I was prescribed Parnate which helped me a lot despite frequent adjustments to my dosage (up to 60 mg) because I felt "hyper" at times or could feel my mood slipping . I tapered down very gradually in preparation for rTMS which requires that patients be Parnate-free for a minimum of 3 weeks. Unfortunately there was a major delay in starting rTMS and my depressive symptoms returned. I was prescribed Manerix, which could be stopped abruptly for rTMS, but discontinued that medication because of side effects. Parnate was restarted but I remained suicidal and had to be hospitalized. An accelerated tapering off of Parnate in preparation for ECT was carried out, but I opted for a trial of Effexor and Lithium instead, and the cardiology consult was once again a non-issue.

After developing a host of physical symptoms, I eventually discontinued both Lithium and Effexor. Thankfully, gynecological surgery this February determined there was no malignancy in my endometrium or ovaries, but I was reluctant to take any medication at this point. It can be very difficult to differentiate between side effects of medication and new physical symptoms that require investigation. Balancing medications for hypothyroidism, migraines and a mood disorder is difficult enough! Not surprisingly, I experienced a return of psychiatric symptoms this June and actually requested that Parnate be tried again. I noticed an improvement (diminished suicidal ideation) soon after starting, but when I increased my dosage of Parnate from 20 to 30 mg, I experienced a pounding heartbeat that started about 30 minutes after taking the medication, and lasted for about two hours. I would need to lie down because I felt lightheaded, and actually napped after the episode because I felt like I had just run a marathon. Hoping that my body would eventually adapt to the medication, I waited 5 days before calling my psychiatrist. He advised me to divide the doses, not to increase to 40 mg as planned, and to see my family physician for an ECG. Although my ECG results were normal, my family physician ordered a 24-hour Holter. I should have the results within the next two weeks, and I'm not overly concerned because the heart palpitations have lessened in intensity and frequency since dividing my doses of Parnate. However, I do find myself short of breath and lightheaded at times and have to rest after most activities (shopping, cooking, cleaning and even showering). I realize this may be partly attributable to depression, but this level of fatigue is new to me (even worse than when I was both anemic and hypothyroid at the same time).

So, my real question is whether or not I should continue with Parnate or reconsider the possibility of ECT if I become more depressed. I was hoping to keep this post concise but include enough information to convey my dilemma. I'm not sure if I succeeded at either but I thank you for reading it.

[rliz]

Sorry, folks. It seems as though this isn't the place for me to be asking questions like the one I posted earlier today. I can't figure out how to delete my original message, so please just ignore it.

[complic8d]

The question wasn't wrong! I just wonder if no one has a good response. I read the whole post but didn't want to reply because I had a really bad experience with ECT. So, I didn't want to throw my 2 cents in.
If they have both helped at different times, but affect you physically, I guess it may be choosing the one that would be the safest, if the docs could come to that conclusion.
Hope you find the right solution, and there are lots of great people here, AND, no wrong questions!
Take care

[Simcha]

I'm sorry you are going through so much, but I think there is a light at the end of the tunnel. I have no doubt in my mind that you are quite capable of taking this bull by the horns, as evidenced by your past in trying to handle this problem.

First of all, I HIGHLY recommend that you make and appointment to see a skilled clinical psychologist for weekly or bi-weekly therapy, in conjunction with med-therapy (if you want to continue meds for depression). Anti-depressants can seldom do the trick alone, and psychiatrists are not adequate for psychotherapy. ECT is only useful for an otherwise unsolvable crisis, and it doesn't solve long-term problems (if it solves anything at all).

I do not know why you would ever be given the option of taking drugs for bipolar disorder, considering that they were not sure if you had bipolar at all, and have not given you that diagnosis yet. I'm glad you discontinued those meds.

I also looked up Parnate on RX List.com: </font><blockquote><div id="quote"><font class="small">Quote:</font>
PARNATE should not be administered to any patient with a confirmed or suspected cerebrovascular defect or to any patient with cardiovascular disease, hypertension, or history of headache.

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RX List Contraindications for Parnate
Personally, if it were me I wouldn't continue with the Parnate. I see it as having no benefit in your case at all if you continue it, and quite possibly harmful to you. I had to look up rTMS/TMS (Transcranial Magnetic Stimulation), and what I found was that there is no evidence that it works at all and is still being studied by the FDA for it's efficacy in treatment of depression.

If you decide to discontinue it, I would make sure that you follow the instructions for discontinuing the drug.

In my personal experience, quitting working only makes depression worse, and people become more isolated and shut-in than they otherwise would have. Believe me, I know. There isn't anyone I know who has depression who has been helped by quitting work altogether. I would discuss this with the clinical psychologist (that you will hopefully make an appointment with) There are alternatives to that step, including a reduction in hours/change of job, amongst others.

I would also encourage you to make an appointment with a different psychiatrist for a second opinion, one that is not connected to your current one in any way, and that doesn't have your current psychiatrists records. A clean, unbiased second opinion is in order here. Sometimes even a good psychiatrist can be biased in his clinical judgment and miss things.

If you have unresolved AFIB, then you really need to be evaluated by a cardiologist for your health. The reasons behind the AFIB you have developed need to be determined and ruled in or out as the cause of your extreme tiredness. All medications and health issues need to be evaluated for the necessity of continuing them.

A family physician is great for a lot of things, but you really need to see a specialist in cardiology to evaluate your heart condition so that it doesn't get worse. The hypothyroidism could even be the cause of your depression, and if you aren't seeing an endocrinologist for the hypothyroidism, you really need to be. There are many causes of hypothyroidism, and many types. Sometimes just by taking something like Synthroid or some other thyroid replacing hormone, you can stop the depression in it's tracks. Other times, there are causes for the hypothyroidism that can be addressed and you won't even need medication.

Likewise, you need to address any underlying issues you may or may not have, such as obesity for instance. If a person has obesity, they can cause a host of serious health problems, such as major cardiac issues. When women go through "the change" and their hormonal levels drop, depression is likely to occur (amongst other medical issues), and that too, must be addressed. Daily migraine medicines can cause all sorts of side effects...

Make an appointment with a clinical psychologist for weekly therapy (at least), and very important---make an appointment with a cardiologist ASAP. I would also see a different psychiatrist altogether, and tell him about the thyroid issues. Maybe he can resolve that without having you see a endocrinologist-- however, with your complicated health issues, I would encourage you to see one anyway.

It's very difficult everything you are dealing with, and no doubt it can be very overwhelming! Good luck, and please let me know how it all turns out for you. You can PM me to let me know if you don't want to address it on here.

[rliz]

Thanks very much for your replies and all the helpful suggestions.

Since my original message was already so long, I may have left out some relevant information. I'll see if I can do that now.

I was diagnosed and treated for hypothyroidism during a psychiatric hospitalization, so my psychiatric is fully aware that it was at least a contributing factor to my depression. The Eltroxin was changed to Synthroid by my family doctor, but my free T3 level remained low despite an acceptable free T4 level. Armed with internet articles from experts in endocrinology on the advantages of a combination T4/T3 medication, my medication was changed once again, and both levels are now within the normal range. My thyroid levels now get checked every 2 months. Ironically, I had asked to have my thyroid levels checked by my family doctor months before I was diagnosed (partly because I was feeling so cold all the time and had many other classic hypothyroid symptoms), but was told everything was okay. Apparently our thyroid levels can fluctuate from day to day.

The neurological problems I experienced between 2002 and 2004 prevented me from continuing my career in IT. The stroke-like symptoms included ataxia (which often made it impossible for me to walk without holding onto walls or furniture), one-sided drooping of my face and eyelid, along with slurred speech. The worst part was the cognitive problems that prevented me from being able to read or remember what I had just done. It was no longer safe for me to commute to work and I was unable to continue my work as an IT consultant. I have only recently regained the ability to actually read a book.

Neuropsychological testing revealed that, despite a high IQ, some of my previous cognitive functioning may never return and that I would have trouble learning anything new, partly due to an inability to concentrate. It was recommended that I see a health psychologist to help me adapt to my disability, but I didn't want to "adapt" -- I wanted to recover! I recently read the book "My Stroke of Insight" by a Harvard-trained brain scientist who suffered a massive stroke. It took her eight years to completely recover and it is one of the most inspiring books I have ever read. She was able to return to work eventually and that is my hope as well. My husband isn't that optimistic as I still have trouble following a recipe and even remembering that I saw a movie or read a book. The upside is that it doesn't take much to entertain me as everything almost everything I do seems new to me.

I also left out some other health challenges I have faced in the past few years. Despite assurances from my family doctor that perimenopause was the only cause for a variety of new symptoms (I'll spare you the details), I knew something was wrong. Being slim all my life (partly from exercise that I use as a natural antidepressant to raise endorphin and serotonin levels), and with no change in my diet, I gained 20 pounds in two months (most of it fluid). With all the risk factors and possible early warning signs of ovarian cancer, I finally insisted on a gynecological consult. In Toronto, you need to be referred to a specialist by your family doctor. After waiting for months, I saw a wonderful gynecologist who did a biopsy which revealed a precancerous endometrial condition. A growing ovarian cyst and fluid in my abdomen weren't encouraging signs, but the surgery was successful and I am cancer-free.

ECT and Parnate were both used only because nothing else was working. I spent many years in psychotherapy addressing psychological issues that may have contributed to depression. While hospitalized for depression, I have had consultations by experts in mood disorders and even one psychoanalyst saw me without reading my chart or knowing my diagnosis.

My brain is actually tired from working so hard, so I'm going to give it a break. I'll post again when I can remember more.

rliz

[rliz]

It's possible that I'm genetically predisposed to a mood disorder. My younger brother is definitely bipolar and my father died at the age of 53 from alcoholism-related health reasons. Although my father was never diagnosed with depression (he was "allergic" to doctors), I'm sure he was self-medicating with alcohol. I don't drink at all and thankfully don't have an addictive personality.

I count my blessings most days and do my best to make my life as enjoyable as possible. Painting (watercolour mostly) and writing poetry are hobbies that I am rediscovering. Although I sometimes miss the social aspect of working, I'm basically a loner and enjoy spending time with my 15-year-old cat.

And now you have my life story (or as much as I can recall for now).

rliz

[rliz]

My psychiatrist has a good sense of humour and no doubt gets frustrated at times. Last time I was hospitalized he actually said, "So nothing short of a lobotomy is going to help". I told him that brain surgery seemed a bit drastic to me.

Funny thing is, deep brain stimulation (DBS) is actually being carried out by neurosurgeons at Toronto Western Hospital for a few patients who have not responded to other forms of treatment for major depression. It has indeed transformed the lives of a few individuals whose depression is clearly the result of a biological anomaly.

Don't get me wrong -- I'm not asking to be put on the waiting list (which is probably a few years long). At least not yet.

[pachyderm]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
rliz said:

Neuropsychological testing revealed that, despite a high IQ, some of my previous cognitive functioning may never return and that I would have trouble learning anything new, partly due to an inability to concentrate. It was recommended that I see a health psychologist to help me adapt to my disability, but I didn't want to "adapt" -- I wanted to recover! I recently read the book "My Stroke of Insight" by a Harvard-trained brain scientist who suffered a massive stroke. It took her eight years to completely recover and it is one of the most inspiring books I have ever read. She was able to return to work eventually and that is my hope as well. My husband isn't that optimistic...

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I've heard of that book and read some others about brain injury. I think you may not "recover" ALL that you were before, but may turn out to be a pretty good specimen after all -- in some ways better than before!

</font><blockquote><div id="quote"><font class="small">Quote:</font>
Despite assurances from my family doctor that perimenopause was the only cause for a variety of new symptoms (I'll spare you the details), I knew something was wrong... a biopsy which revealed a precancerous endometrial condition. A growing ovarian cyst and fluid in my abdomen weren't encouraging signs, but the surgery was successful and I am cancer-free.

</div></font></blockquote><font class="post">

It is WE who have to keep those doctors under close watch...

[rliz]

Thanks again for all your supportive replies.

I'm happy to report that I saw my family doctor this morning and she told me that the results of my 24-Holter monitoring were "unremarkable". That means I should be able to continue taking Parnate (even increasing the dose if necessary) until my psychiatrist can come up with a viable alternative.

Despite my continuing need for frequent rest periods throughout the day, my family doctor told me that I'm probably just overdoing things. That's a bit difficult for me to believe given how little I actually manage to accomplish these days.

In any case, my main point was to share GOOD news. Now I'll go have my nap.

[skeeweeaka]

Rliz...I am so sorry to hear about your condition. It seems that you have really been through a lot but seem to be dealing with it well. I, too, suffer from bipolar/major depression and seizures...as a result I have lost a great deal of cognitive abilities as well. I say that to tell you that I know how frustrating this can be. I also was placed on disability and am unable to practice my professional career which I loved.

It seems after all of your experiences, you are still brave enough to try these medicines, but I really attribute a lot of my complications along the way to the medications that I took... I for one am concerned about the Parnate and the fact that you have neurological deficits that may have been caused my some of the meds... I personally would not take them... My meds caused the seizures that I have and I will have them for the rest of my life...

I guess I am just saying, please be careful with those meds, I don't think they are the best thing for you...IMHO ECT I doubt if they will give it to you now...because of the complications....

TJ

[rliz]

Hi TJ,

I don't mean to sound overly dramatic, but it really is a matter of life or death. I asked to be put back on Parnate after thinking about, and making preparations for suicide.

The last time I did that, I had actually written a letter addressed to the Coroner's Office to help them process my case so I could be cremated as soon as possible. It took me two weeks to write the letter because of my cognitive problems. My husband sensed something was wrong and escorted me to my psychiatrist's office. I was admitted involuntarily and it took two months before I could even remotely consider staying alive. It seems that once I reach a certain point, there is no turning back for me without some form of treatment.

Before restarting the Parnate this time, I was just on the verge of being acutely suicidal. I can honestly say that is no longer the case, and the only thing that really changed was me taking the Parnate. Thankfully this medication works quickly for me. I 'm so glad I was able skip the hospital part this time, although I now know that my husband was keeping a close eye on the situation.

For those people who have never considered or attempted suicide, there is no way for me to explain how it is possible to get to the point where it feels like the only option, regardless of how much loved ones will inevitably be hurt.

The only explanation I have for myself is that, for me and many others, this is just one part of major depression. That's why it's so important for people with mood disorders to be properly diagnosed and treated. Sometimes the treatment itself causes damage, and I am very sorry that is the case for you.

My cognitive difficulties (aside from some temporary memory loss after ECT) developed during the time I was experiencing neurological problems. I stopped my antidepressant medication, hoping my symptoms would go away, but they got progressively worse during a two year period. My husband first noticed signs of cognitive problems long after I was off of antidepressant medication. Although the cognitive problems remained and I had to work very hard to regain strength on my left side, my stroke-like symptoms stopped when I started a strictly gluten-free diet (which is a whole other story).

Thanks for taking the time to respond and for caring. I wish you all the best!

rliz

[skeeweeaka]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
rliz said:
Hi TJ,

I don't mean to sound overly dramatic, but it really is a matter of life or death. I asked to be put back on Parnate after thinking about, and making preparations for suicide.

The last time I did that, I had actually written a letter addressed to the Coroner's Office to help them process my case so I could be cremated as soon as possible. It took me two weeks to write the letter because of my cognitive problems. My husband sensed something was wrong and escorted me to my psychiatrist's office. I was admitted involuntarily and it took two months before I could even remotely consider staying alive. It seems that once I reach a certain point, there is no turning back for me without some form of treatment.

Before restarting the Parnate this time, I was just on the verge of being acutely suicidal. I can honestly say that is no longer the case, and the only thing that really changed was me taking the Parnate. Thankfully this medication works quickly for me. I 'm so glad I was able skip the hospital part this time, although I now know that my husband was keeping a close eye on the situation.

For those people who have never considered or attempted suicide, there is no way for me to explain how it is possible to get to the point where it feels like the only option, regardless of how much loved ones will inevitably be hurt.

The only explanation I have for myself is that, for me and many others, this is just one part of major depression. That's why it's so important for people with mood disorders to be properly diagnosed and treated. Sometimes the treatment itself causes damage, and I am very sorry that is the case for you.

My cognitive difficulties (aside from some temporary memory loss after ECT) developed during the time I was experiencing neurological problems. I stopped my antidepressant medication, hoping my symptoms would go away, but they got progressively worse during a two year period. My husband first noticed signs of cognitive problems long after I was off of antidepressant medication. Although the cognitive problems remained and I had to work very hard to regain strength on my left side, my stroke-like symptoms stopped when I started a strictly gluten-free diet (which is a whole other story).

Thanks for taking the time to respond and for caring. I wish you all the best!

rliz

</div></font></blockquote><font class="post">

Rliz...I hope I didn't come off as not being understanding because I thoroughly understand... I have been suicidal many a time....and atttempted it.... I understand the pain and desperation you feel to simply alleviate the depression and suicidal thoughts... I guess I'm just tired of all the meds myself....and feel like none of them have done many any good.... Your story breaks my heart and I so feel your pain...I'm so sorry this has happened to you...
It is definitely a horrible way to live...that I know!!!

You're right, other people just don't and won't get it unless they live through it...

TJ

[rliz]

TJ,

You didn't come across as not understanding in any way, shape or form. I just wanted you and anyone reading this to realize that my decision to restart Parnate wasn't taken lightly. I still don't feel completely well, but I definitely feel better, and that's really all I can reasonably hope for at this point.

I have been haunted by thoughts of suicide since I was 12. My first attempt was at age 14 and I never told my parents or anyone else. I told my mother I probably had the stomach flu when I looked and felt like death warmed over.

I know that most people on this site have seriously considered, attempted and nearly succeeded at ending their lives. It breaks my heart to realize that some people don't have the benefit of a support system to give them a better chance at surviving and hopefully feeling better.

I've found wonderful support here and I want you to know how very grateful I am.

Hugs,

rliz