Nursing & Depression - page 23
While visiting in the lounge one day, we discovered that every nurse there was on an anti-depressant. I have had 'Treatment Resistant Depression' for about 20 years--as long as I've been a nurse. ... Read More
Oct 23, '02Joined: Sep '02; Posts: 672; Likes: 29psychnurse....well, you asked for it, haha........here's my list, I meant to group it in order of type of med, but I pasted it from an older list to save time, and added bits here and there, so they are all mixed up. Hope I don't bore you!
Nortryptiline: I have been on this twice, after the births of my children. Worked "fair", but side effects were awful, did not diisipate much over time.
Zoloft: I have been on this at least 3 times, at first on pretty low doses, later up to 200mg. Higher dose worked "fair", pooped out after several months and also caused pretty nasty bruxism.
Prozac: I have been on this maybe 2-3 times. It has worked well for me, at doses of 60mg.....always poops out. At one point, I was taking a different antidepressant for everyday, and took 20mg Prozac for 2 weeks premenstrually. Worked great, stopped when I a)went on lupron b)went off lupron and on continous bcp's c)went off those and had a hyst. Oh, had minimal side effects with prozac. Some bruxism when on 60mg for long period of time.
Trazadone: take for sleep, works wonders
Paxil: didn't seem to help, chose not to increase dosage due to side effects (sleepiness)
Remeron: didn't seem to work , decided not to go with increased dosage due to side effects (hunger, weight gain, excessive sleepiness-ie zombie)
Buspar: no effect -none at all, on anxiety
Wellbutrin: 1996, then again 2000-have been on ever since then.; works well, but I can not take it alone, I always need something else to augment (this has pretty much been the case with all antidepressants, for years)
Cylert: seemed to work somewhat-=former Pychiatric nurse practitioner thought "maybe" I had ADD, both kids have it, *I* was never formally tested
Lithium: never really worked. Gave me hand tremor, and my affect was "off". I felt very strange on Lithium. Not normal. Edema despite watching diet, weight gain above and beyond edema.
Neurontin: seemed it may have worked for a while as augment to andtidepressant, helped with the anxiety. Gained 50lbs while on it.
Ambien: on and off, for sleep. Works well. 10mg.
Effexor: worked fairly well for a while at max dose, than pooped out
Celexa: some effect, didn't last long-was on max dose
Serzone: had a weird doc at the time, kept taking me off, and later putting me on. It never helped at all, even at max dose.
Risperidone: have been on twice as "augment" to antidepressants; seemed to help somewhat, but it made me very, very tired, (ZOMBIE)and that effect never really went away.
Zyprexa: used to "augment" antidepressant, did ok for several months, then I pooped out. MD chose not to increase dose.
Depakote: was on briefly, after Zyprexa stopped helping.....was hungry 24/7, even below blood level, I did not want to increase, for fear of gaining weight (I am already 40-50lbs overweight)
Topamax: I am currently on this to augment the Wellbutrin, now at 200mg (recent increase from 150mg). was doing great, but as you see, what I am taking now is not effective for whatever reason.
At one point I was on Xanax, used sparingly for anxiety, was good about it, till one night I swallowed a handful and some other stuff and went inpatient, and since then, no more benzos for me (although I do take librax for my GI probs, but I'd hardly swallow a bottle of that, I'd live through it, and be terribly constirpated for ages)
One doc wanted to try Provigil, but since it is quite off label, and only starting to be tested for depression (at least at that time)my insurance would not cover any penny of it, and it is quite pricey!
I have for the past several years taken combos of antidepressant, usually with either a different type of antidepressant, or with another type of med, as you see the different types listed above. My current psychiatrist tends to think Wellbutrin is the best choice for me (I take the max dose), and he likes to mess with the alternate meds used in combo. My former docs would fiddle and fiddle a lot. I feel like I have been on the big med merry go round (I hope I didn't forget any).
Well, I need to go, my kids are acting like monsters, I have work to do, (paperwork of course), and I'm having pain below my right rib cage (hmmmmmm, got a call today re the ressults of last weeks HIDA scan, but too late for me to return her call, I'm curious what the results were????)
Thanks so much.....
Oct 23, '02Joined: Sep '02; Posts: 672; Likes: 29Youda
Sorry about your rotton day. It really *could* be just that. I hope so, you've been sounding so good lately. Keep us posted.
Oct 23, '02Joined: Jan '02; Posts: 5,673; Likes: 159Sphinx, I think agency is a viable option you might consider to gain more control of your life...as you can work 1-2 shifts per week and make more money than FT staff, you have more free time. Some love it...some hate it...but it never hurts to give it a try.
I know many nurses who would do nothing else but agency. If you are the independent, flexible type who likes to go in, do your job and leave, you may enjoy it. We expect to get the patients the staff doesn't want, and focus on doing a great job while we're there. The great thing about agency is we stay out of politics. We also never have to go back to a hellhole if we don't want to
I did agency for many years and it was good for me...trouble is sometimes there are 'dry spells' and for that reason I stayed on staff somewhere PRN so I could plug in there when needed..
If you don't need benes, PRN is a great way to control your workload too...and make your own hours.
I hope you can afford to take a long vacation soon..or cut your hours....and rest up...so you can feel better.
Oct 24, '02Joined: Oct '02; Posts: 228; Likes: 2Oh, Sphinx - I read the note about "I know I'm bothering" - something like that (haven't worked on how to bring down a quote - too lazy) and said, "My god, that's me. I feel the same way when I'm down bad." Since I know that you are NOT bothering me or anyone else posting, I think maybe it's OK for me to vent, talk when I feel like I shouldn't.
Youda - I am slowly, finally, figuring out that part of depression is believing that what I feel now is forever. That only happens when I feel bad though. When I feel good, it's only temporary. I try very hard to remind myself that one bad day does not mean the rest of my life is bad. It's very hard, I'm getting better at it - for now. I may get worse at it for a while - but I retain a little more of the memory of things passing then I used to.
For meds - I have gone through many of the same things Sphinx, and probably everyone else has. First meds ever tried were the TCA's (tricyclics) - never helped, bad side effects. Don't know if I ever stayed on for > 1 month - might have worked with endurance (now they say may take much longer than thought to kick in).
Finally a psychiatrist took a risk and put me on an MAOI (Parnate). In the beginning I used to think, "Well now I can kill myself with a pepperoni pizza." This is an example of depression humor. But the guy was right. TCAs and MAOIs were only available meds at the time, he had read that the second was much more likely to work on someone with atypical depression so I was willing to take the risk, learn what would be dangerous and not, and after a few weeks, I felt like I had a reason to get up in the morning. It was a miracle.
It worked well for a while. Then I went to nursing school, got my first job as an RN and my depression was getting worse and worse. There were other stressors but I think nursing can contribute - the environment where you are told you must be perfect at all times, if not, you are reprimanded, no excuses accepted. I reached a point where I sought help again. Went to a psychologist, he spent 5 minutes with me and said, "I think you need to see the psychiatrist." He was a good one. After trying to up my parnate, we figured it wasn't working, try Prozac, just out. Needed a wash out of course. Two weeks later, I'm feeling fine on nothing (in retrospect, the increased dose of parnate was kicking in). Said let's see how I do. He agreed but wanted to keep a close eye on me.
Needless to say, within a week I was thinking only about ways to kill myself. Somehow I heard a voice in my head, I know it didn't come from my mind, that said, "Maybe it's the meds." I didn't think so, but I called the shrink that day, he thought it was the meds, started me on Prozac the next day. A few weeks later I wasn't thinking about suicide anymore.
So, over the years I've experienced much of what everyone has. I've been through Wellbutrin, Zoloft, Effexor and Celexa. I always refused trully sedating ones because fatigue has always been an integral part of my depression. Tried on synthroid as an adjunct - nothing. Tried on ritalin as an adjunct - worked for a while then made me more tired than awake.
So far, most success from Celexa and Provigil. I know Provigil is "off-label" but it's not that off label. There is a fair amount of stuff in the literature documenting its efficacy in some cases. I have learned that you can fight with insurance companies and sometimes win. It helps enormously if you can get your shrink to do it for you, Sphinx, but there is a chance.
In summary, only antidepressants that have worked for me are SSRIs and MAOIs. Atypical, hard to treat depressions are the only ones where they still mention using MAOIs if SSRIs are not working. Only adjunct that has worked is Provigil - it is a "wake-promoting agent" that is not an amphetamine.
MAOIs may be worth a try but they are risky. They interact with lots of foods and can cause malignant hypertension. They interact with lots of meds, with Demerol they cause malignant hyperthermia. So, with caution, they could be helpful. Defintely need a washout period, no provigil, ritalin or anything with it, etc. But - possibly worth a discussion.
I've also heard more about Lexapro - it's Celexa without the bad stuff, I was told. In fact I'm about to try it. I'll let you know how it goes.
One last thing, though I've gone on to long. I try to ask myself what is most important. In the case of pumpkins I might say, "which do the kids need more right now - pumpkins or a mother who is alive?" When I worked home health I got fed up with being dumped on as the full time nurse and went per diem. A bit less financial security but the stress reduction was worth it to me.
Hope this has been helpful. Sphinx hang in there. Youda, you too. Even the bad stuff passes in time.
Oct 24, '02Joined: Oct '02; Posts: 1,079; Likes: 53Yes YES I was about to suggest parnate, too! The new SSRI is called lexapro-It's escitalopram whereas celexa is citalopram. Bet the doc is willing to give samples as it is being intensely marketed(What isnt?) Hang in there gals I'm rooting for you!
Oct 24, '02Occupation: a just a nurse contemplating the nature of my career..... Joined: Oct '01; Posts: 2,344; Likes: 21this is turning into a great knowledge/support board..........
hang in all
Oct 24, '02Joined: Oct '02; Posts: 1,079; Likes: 53Housework should be at the bottom of anyone's list. Tell everyone they need to keep a path clear at the center of each room...
Oct 24, '02Joined: Nov '00; Posts: 931; Likes: 18LOL! psychnurse, I love your posts!
I wish I'd have seen your post sooner, though. I might have gone to the mall instead of cleaning . . .
Oct 24, '02Joined: Oct '02; Posts: 1,079; Likes: 53Youda you have my permission to go to the mall tomorrow instead...
Oct 24, '02Occupation: RN and blogger extraordinaire Specialty: 20 year(s) of experience in LTC, assisted living, med-surg, psych ; From: OR, US ; Joined: Sep '02; Posts: 26,953; Likes: 44,667Hi guys.....I was just at a training seminar where we all got a 20-minute spiel on the benefits of Lexapro vs. Celexa and the other SSRIs. With Lexapro, smaller doses are used, which supposedly cuts down on side effects such as weight gain and sleep disturbances. It's almost the same chemically as Celexa, but they've left out the parts that cause all those problems and it is supposed to be well-tolerated by the elderly and other vulnerable populations. Now, my Paxil works pretty well and I'm not looking to change horses in mid-stream, so to speak, but I'd like to hear from anyone who does try it---I'd be willing to experiment a little, but ONLY if it works well AND doesn't put on weight (I've gained 40# since I went on the Paxil 1 1/2 yrs. ago).
Oct 25, '02Occupation: LTC Joined: Feb '02; Posts: 29; Likes: 8i have been trying to post a reply for days
i geta 'vbulletin' that says i cannot access the site
i go to the bottom of the box, delete 'unregistered' and type in my name and pasword.
sometimes i get the same box again
i repeat the above and get the same responce again
sometimes i get a reply page full of goodies i don't know how to use
but it has my name 'carpe_de_em' on the top and says i am logged in
i scrool down and type heart and soul and when i submit the reply, i get the same box.
i have tried contacting allnurses but get no responce
this is the third time this am i have tried to post this reply
can anyone help???
Oct 25, '02Occupation: LTC Joined: Feb '02; Posts: 29; Likes: 8my depression is till out of control. i only leave the house when i have to or if sig/othr is w/ me. i want to sleep all day, i don't want to talk to anyone. I wish there was no tomorrow. I cried again last nite.
i see my doc today--the one that asked for resourses to prove Adderol use in treatment resistant depression. I only have three articles. I tried mdzine, nursezine, medscape and veritasmedicine. Either they had no info or they wanted money for it'
I could still use some help from research hounds. I can provide e-mail address (which is also in my profile) or a fax # if anyone can help.
since it finally accepted my previous post i am sending this b4 it changes it's mind. I have tried 8-10 times in the last 3-4 days to post but run into rejection everytime.
you all have become a sourse of strength for me. i hate not being able to respond when you hurt. i try over and over and cannot get through.
if this message doesn't go i'm going to throw something!!
Oct 25, '02Joined: Nov '00; Posts: 931; Likes: 18Hey, carpe_de_em!
I don't have any idea what happened with your computer, or trying to post. It's working now, though!
I see you did some research mostly in nursing, what about some of the MD journals?
Sure know what you mean about not leaving the house. If someone would deliver groceries to me, I'd probably not come out of my house ever!