Depression, slow weight loss, labs and pathetic whinging (long)

Why yes, I would like some cheese with this whine, preferably a really stinky gorgonzola. I am in a large funk and this will most likely come across as pathetic whinging of the worst sort. There’s a lot here because I’ve been wagging all this emotional **** around for months and haven’t really done anything with it bu****ch it percolate into something ugly.

I’m breaking in a new PCP, which is a pain in the ass. I’ve seen him twice and he’s ok. Wrote refills for all my scripts and didn’t balk at ordering the Lab List O’Doom, so that counts for a lot. He just doesn’t quite have the bedside manner of my last 2 docs and he doesn’t know me well enough to believe I do, in fact, know what I’m talking about when I tell him which meds do & don’t work for me or why I take such a ginormous dose of A, D, E and all that other stuff. Y’all know ALL the words to this tired song.

My antidepressant has stopped working. I’m moody, irritable (yes, WAY more than usual) and on the verge of tears several times a day. I’ve been taking Cymbalta for 3 or 4 years. I started it when Wellbutrin stopped working – which really pissed me off. It was my magic bullet. Cymbalta worked ok, just not quite as well as Wellbutrin. So I go to New PCP. He does the whole risk assessment thing and wants to refer me to the local psych hospital if I’m suicidal. I used to work there and wouldn’t refer my cat, but I assure him that not only am I not at risk, I work in a building full of therapists and have 24/7 access if I need it. Not to mention I have been a therapist for oh, 20+ years and will not hesitate to get help if I need it. Ok, he finally gets I’m not going to pull a Madame Butterfly in his office. I’m sort of patient – the man’s just doing his job.

He wants to add either Seroquel or Abilify. I know this is the latest trend and it works well for lots of people. I do not, however, want to deal with the weight gain that comes with any dose of either of these antipsychotics, thankyewverymuch. New PCP got a little pissy when I said as much. O.o  I was willing to either add Wellbutrin or switch completely to Wellbutrin (SSRIs have little to no effect on me and Effexor made me crazier than a ****house rat). He added Wellbutrin 150mg q am and kept the Cymbalta. “It’s a far better drug than Wellbutrin," he says. It’s been a week, so technically the jury is still out, but so far, no change in mood. Color me unimpressed in a vile shade of mustard with green undertones.

The frigging thyroid labs are STILL not quite right, but the Endo thinks they’re close enough not to monitor anymore. O.o I know the mood stuff could be thyroid-related, along with a lot of other stuff. I’m so beyond over the thyroid crap and the new doctor crap, I’m not going to say anything else about it for fear I’ll slam this laptop up against the wall. Short fuse much?

My last labs (5/27) were ok for some things and **** for others. I pretty much stopped taking vites in January for several weeks and didn’t get back on them consistently until late April/early May. I know. No excuses, but I *am* back on them now. I’m not quite back at square one but the progress I made with D & A is pretty much gone and my iron is ****e. I will re-lab in September.

The main thing that concerns me is my protein numbers are down. WTF? I eat and supplement as much protein as I can shove in my face. I have to do shakes because there simply is not enough room or hours in the day for me to eat 100+ grams of protein. I snack on meat, Fage yogurt, cheese, or (wait for it)…meat. About once every couple of weeks, I eat lunch at a Mexican place and have chips & salsa before meat. I eat part of a baked potato (after meat) maybe once a week. I eat green veg or salad (with & after meat), but not every day. I’m way serious about getting the protein in and have been since I could eat real food post op. I’m auditioning egg white protein because I think the whey is causing gas & too-frequent bms. My anus and I are way the hell over that too. I’m open to suggestions for upping protein.

Labs:

Albumin dropped from 4.7 to 3.8. Range: 3.5-5.0

Prealbumin dropped from 27 to 21 Range: 20-40

Total Protein dropped from 7.9 to 6.5. Range: 6.3 - 8.2

A/G Ratio up from 1.3 to 1.4. Range: 1.4 – 1.9

The whole spreadsheet is on Google docs.

There’s been a major slowdown in weight loss. I thought once the thyroid numbers got closer to where they’re supposed to be that would change. I’ve lost between 25 & 35 pounds (depending on the scale’s mood du jour) in the past 8 months. That’s great and I certainly don’t want it back, but I really hoped and expected to weigh a lot less than I do at this point. I’m 15 months out, have lost about 120 pounds and have another 80+ pounds I want to shed. I’m glad to be able to say I’ve lost 120 pounds. I’m disappointed and trying REAL hard not to be discouraged that the rest is coming off soooo slowly, but it’s very, very hard just now.

I’m not looking for THE answer or sympathy or an ass-chewing – but if any of you think I need any of the above, I’m all ears. Srsly. Suggestions about getting more protein in would be great. I tend to isolate when I’m depressed and got very distant from my main source of enlightened support, which was a real dumbass move on my part. I mainly want y’all to know where my head is (besides chronically in my arse) and what’s up with me. I’ve received so much support from everyone and I appreciate it very much. If you’ve read this far, thanks a bunch.

7 month post-DS psychiatrist here. I've made myself a semi-expert on post-bariatric surgery psychopharmacology, as it's a niche area that is totally vacant, and interesting to me, as I have had DS.

Sorry you're feeling so crummy. Regarding the Cymbalta, it is an extended release medication, and so in all likelihood you're not absorbing much, if any of it. I might guess that's why it stopped working. Regarding the Wellbutrin, I suspect he's prescribed the XL based on the dose, and you likely won't absorb it, so I'd request the immediate release. You might just switch back to immediate release Wellbutrin three times daily and see what that does for you. I think you're right to be leery of adding an atypical antipsychotic. The metabolic side effects, even at low doses, are exactly what you had the DS to eliminate. No point taking a medication that will induce insulin resistance unless you absolutely have to. Plus there's the risk of movement disorders that your PCP likely has no idea how to monitor for. 

Honestly, it might be a reasonable idea to call up your surgeon's practice and see if they have a psychiatrist that they refer to who has some experience with bariatric surgery patients. Your PCP is honestly proving himself to be clueless in managing psychiatric medications post-DS.

I wish you the best of luck.

Thanks loads and stars in your crown for the psychopharm expertise. I have been so scattered, I didn't even think about the bloody XR factor. ugh. Will chat up New PCP and see if he's up for that. I'll also call Dr. H and see what's what in Nashville.

That whole antipsychotic thing just gives me the icks. I don't want to be the only DS kid in Jonesboro doing the Thorazine Shuffle.

On July 12, 2011 at 5:28 PM Pacific Time, dbaldes wrote: 7 month post-DS psychiatrist here. I've made myself a semi-expert on post-bariatric surgery psychopharmacology, as it's a niche area that is totally vacant, and interesting to me, as I have had DS.

Sorry you're feeling so crummy. Regarding the Cymbalta, it is an extended release medication, and so in all likelihood you're not absorbing much, if any of it. I might guess that's why it stopped working. Regarding the Wellbutrin, I suspect he's prescribed the XL based on the dose, and you likely won't absorb it, so I'd request the immediate release. You might just switch back to immediate release Wellbutrin three times daily and see what that does for you. I think you're right to be leery of adding an atypical antipsychotic. The metabolic side effects, even at low doses, are exactly what you had the DS to eliminate. No point taking a medication that will induce insulin resistance unless you absolutely have to. Plus there's the risk of movement disorders that your PCP likely has no idea how to monitor for. 

Honestly, it might be a reasonable idea to call up your surgeon's practice and see if they have a psychiatrist that they refer to who has some experience with bariatric surgery patients. Your PCP is honestly proving himself to be clueless in managing psychiatric medications post-DS.

I wish you the best of luck.
  dbaldes

I hope CharleeG won't  mind, but I'm going to kidnap her topic to ask a related question.  In your post, you mention 'taking a medication that will induce insulin resistance".  Were you referring to Seroquel or Abilify?  Is that why they tend to cause weight gain?

If you would, please comment on antidepressants for the non surgical diabetic (that would be me).  I recently read that antidepressants may cause a increased potential for causing diabetes.  Can antidepressants cause elevated blood sugar in the already diabetic?

I see my psy doc tomorrow and will ask these questions but I would love your opinion.

Sorry for the interruption, now back to CharleeG's topic.

Thanks! Janis

 Well, you've had a rough way to go with the meds - but you haven't lost your sense of humor.   That's a good thing.

As a health professional yourself, you know that with your new PCP, you need to advocate, advocate, advocate.     Sounds like you're doing well on that.   Better than me.  I've just tended to bury my head in the sand and avoid seeing doctors altogether, after my experience with a disappearing endo doc.     I must get on that.

Slow weight loss?    I see so many that struggle with this who are on antidepressants.   I hope others who are using them speak up, as I don't have much experience with that.

Protein?     It doesn't matter what I did, for the longest time, I struggled with my protein levels.   All of a sudden, they popped up.   I'm not sure if it's because I got my zinc up (which affects protein) of if I just started absorbing more, but a year ago, they went up.    The ONLY two whey shakes I can tolerate are Designer Whey and the Syntrax Nectars.    I like the Designer Whey because it doesn't have that nasty whey scent and taste.    You might want to try some of that.    I've been mixing it with some cold espresso, s/f syrup, cream and water and ice, and this anti-whey shake girl is slowly becoming a convert.

Thanks love. You know me - I'll be the one cracking wise on my way to the hangman. I will give the Designer Whey a try. If it doesn't work, I'll try Syntrax again. Freshly post-op, I spewed every time I had one. They hated me and the feeling was mutual.

Hey Charlee,

Here's my thoughts for what they are worth:

I think you should try Abilfy.  It is not known as a weight gainer, not like seroquel  anyhow.

If your iron is low couldn't that be causing some of your feelings that you are attributing to depression?

If your pcp wants to refer you to the psych hospital why didn't he refer you to a psychiatrist to manage your depression?  That would be what I would recommend.  You must know who the best psychiatrist around you is and have contacts that can get you in, right?

I went through some horrible depressions and irritable depressions along my journey as a lot of people here remember.  It got a lot better for me and I think it will for you too.

As for hurrying up the weight loss I have no idea.  Maybe you are going too low carb?

Hugs,

~Becky

 

Thanks, Becky. I want to give Wellbutrin a chance (and the non-XL if the XL doesn't work) before going with Abilify. It will be a very last resort.

Low iron and low something else can either mimic or contribute to depression - can't remember which. It's definitely a possibility. I've been anemic before and this feels more like the meds not working.

I do know most of the local psychiatrists and there are only a couple I'd be willing to see. Unfortunately, I work with one and the other works for another agency and doesn't do private practice, so no prescription love there. I'll get them together at lunch and pick their brains - that's definitely doable - and all legal and ethical too.

when I upped my protein to break a stall which someone told me to do, and it worked, I went for eating protein instead of drinking it as shakes nauseated me for awhile. It did work wonderfully tho. I startred with a brisket roast and ate a few platefuls over the next couple days. I also ate egg salad with lots of mayo & tuna salad in the beginning instead of shakes.  I grazed on cheese & nuts also.

I also am on anti-depressants and am on 3 doses a day but since they are sposed to be 6 hours apart I find myself short on time to get the 3rd one in. I am sleeping longer than I used to tho 8-10 hours most nights. I am on Effexor but had trouble with Wellbutrin and Cimbalta didn't work at all. We are all different. Even with taking one less pill most of the time I think my depression is lessening because I am happier with the lost weight. Not sure but I do know I find it necessary to see a psychiatrist every few months who is adept at asking all the right questions to determine if the right vitamins are taken, if I have enough sunlight exposure, social contacts in place, on & on & on as so many things do contribute to depression. I would defintitely look into one even tho you are all around therapists it is different to actually have one tending to you.

Thanks!! What you're eating sounds like what I'm eating. I keep some kind of roast beast cooked and handy, deviled eggs, tuna or chicken salad - to the point I think I may grow fins AND cluck. LOL

Funny how similar meds affect people so differently. Effexor darn near vibrated me out of my skin - couldn't sleep and was almost twitchy.

I would love to have the one-stop shopping thing with a doc, but I think my needs vary so, that's just not going to work. Maybe an internist. But yeah, I will def talk to my psych buddies. If nothing else, they can steer me to someone besides the local Xanaxologist. ;-)