Here Comes The Sun

In my previous blog post I talked about how discouraged I was because in the four months since having my Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) for my treatment resistant depression I hadn't had any improvement and I mentioned that I probably wouldn't be posting again until after my 6 month follow-up appointment unless something changed.  Well, I am pleased to report that after years of having a steadily increasing depression, I have had an improvement in my mood over the past two and a half weeks.

At my last follow-up appointment, Dr. Levitt, the psychiatrist for the study in which I am taking part, gave four suggestions for changes in my medication that may help me.  The first suggestion that we tried made no change in my mood, so we abandoned that.  The second suggestion that he made was to increase the dosage of the medication that I have been on.  I have been on the medication Fetzima for a couple of years now.  I have been taking 120 mg for that entire time.  That is the maximum recommended dosage for Fetzima and my psychiatrist was hesitant to give me a higher dose because Fetzima is a relatively new medication and he hasn't had anyone on that high of a dose yet and neither had any of his colleagues.  I tend to get bad side effects from medications, so he didn't want to give me a dose that he had no experience with.  However, Fetzima was one of the few medications that I was able to take at full dose without any side effects and it seemed to help me with my anxiety, so we continued to use it at 120 mg.  Dr. Levitt suggested that we increase it gradually to 160 mg or 180 mg to see if it gave me any more positive results and since he had experience with prescribing it at that high of a dose, my psychiatrist agreed to increase it.

We first increased my dose to 140 mg.  The next day I noticed a significant change in my mood.  I was no longer crying all the time.  I wasn't saying "I'm not doing well" or "I feel bad" to my wife all of the time.  I didn't spend all day thinking to myself "I feel horrible" or "I'm not feeling well", instead I was thinking to myself "What am I feeling?" and "Why am I feeling this way?".  I didn't feel sad all of the time.  Thus, it was a pretty significant change in my mood.  The change lasted for the full two weeks until my next psychiatrist appointment.

My psychiatrist uses the Quick Inventory of Depressive Symptomatology (QIDS) test to determine how depressed I am at each appointment.  Over the past several years my score has always been in the 19-21 range, which scores as Severe Depression or Very Severe Depression.  After increasing my Fetzima dose to 140 mg I scored at 14, which rates as Moderate Depression.  Therefore, the increase in my mood was significant.

It's hard to know what caused the improvement.  Was it just the increase in my dose of Fetzima?  Is it the MRgFUS finally kicking in?  Is it a combination of the two?  I tend to think that it was a combination of the two that has brought about this change.

Even though I have had a significant improvement in my mood, it is important not to overstate how well I am doing.  I am still down.  I am still in a depression.  I am not feeling happy yet.  Hence, at my last appointment, my psychiatrist increased my dose to 160 mg.  Unfortunately, the increase in dose this time did not have the immediate impact that the increase to 140 mg had.  I haven't noticed any change since the increase to 160 mg.  It may take time, or I may have to increase it to 180 mg, or I may not have any further improvement, or I may slip back into my severe depression.  It is hard to know.

At this point however, I am glad to just be experiencing this improvement in my mood and hope that it continues into the future.