Nursing & Depression

abrenrn · Oct 24, 2002

Oh, 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.

Thank you.

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.

Anne

sanakruz, ADN · Oct 24, 2002

Yes 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!

micro, RN · Oct 24, 2002

this is turning into a great knowledge/support board..........

hang in all

micro

sanakruz, ADN · Oct 24, 2002

Housework should be at the bottom of anyone's list. Tell everyone they need to keep a path clear at the center of each room...

Youda · Oct 24, 2002

LOL! 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 . . .

sanakruz, ADN · Oct 24, 2002

Youda you have my permission to go to the mall tomorrow instead...

Long Term Care Columnist / Guide · Oct 25, 2002

Hi 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).

carpe_de_em · Oct 25, 2002

i 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???

carpe_de_em · Oct 25, 2002

my 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!!

Youda · Oct 25, 2002

Hey, 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!

sphinx, BSN, RN · Oct 25, 2002

More and more and no end in sight...........as for med changes, my latest psychiatrist isvery conservative, very hesitant to make changes, esp a big one like to an MAOI. That would be a BIG change, too. I've thought about it, but's that *all* I've done, is thought. After he increased my Topamax, we discussed my current stress level, and he wants me to get back to him when I can decrease my stress level, or our next appointment. His answer is always "therapy". Now, I'm not knocking therapy, but I've always had a hard time finding someone I click with, then there's the scheduling problems......it is very hard to work weekly or even biweekly therapy into my schedule! And frankly, that stresses me out even more!!!! Meanwhile, the GI problems go on.....I did have a bug of some sort, but I'd thought then that it lasted so long is cuz I have other issues. Last week I found out I have gastritis. Not a huge deal. Certainly stress related. Also, For almost 2 years I've had some sort of chest and/or epigastric pain. Last year at this time it was so severe, when I tried to have a BM it was like a butcher knive being jabbed into my belly-and twisted. At that time I had an abdominal ultrasound-negative. I had blood work, just slightly (slight) elevation in lipase level, which creeped up a little more, then dropped to nromal. Had an abdominal CT scan, also negative. Pain diminished.....more recently started with chest pain, referred to GI doc who did endoscopy and HIDA scan. Endoscopy last week found the gastritis. Got a call this week with results of HIDA scan, and guess what, my gallbladder is "dysfuntional", not emptying properly or some such. Ironicaaly, past two week, have been starting to have pain on right side, and had alwasy po-pooed the idea of it being my gall bladder since I didn't have any classic signs. Yesterday was so bad, it pained nelow my R ribs all day so bad, even though I hadn't eaten, then when I had a granola bar with a measly 6g of fat, I had that hideous stabbing pain in my epigastic area. 2 people, including a patietn told me I looked like hell, and pale, and I should go home and rest (I did). Had a short day today, and am getting ready to nap. About 10 peole this week have told me how pale I look. Anyway, I was told about low fat diet...yeah, well for the most part I do eat low fat, with occasional splurges like pizza once a week. I have this pain every day regardless of what I eat. I have had it all day today despite having only oatmeal (4g fat) in the am, then just now yogurt with no fat. The PA mentioned having my gallbladder out. I'm thinking that might be a good idea, but don't want to rush into things. I am depressed, in pain, tired and confused. I am just tired of being alive. (yeah doc, cut out my gallbladder, and don't worry if the knife slips, haha).....

sanakruz, ADN · Oct 25, 2002

Sphinx- pain and depression follow the same neural pathways- If you are depressed you hurt more and if you hurt your depression worsens. I always tell clients at the clinic the best tretment for depression is med and therapy- I know its hard to click with some body> Seems like this BB has turned into a support group of sorts. Ask your doc to help you find a group in your area. Face to face therapy is effective, honest. And get rid of that foolish gb (The nerve of that type of betrayal! And at a time like this!)

Nursing & Depression

Nurses and Depression/Anxiety