19 replies to this topic

[DarkRiver]

This is a long story but I'll make it as clear and succinct as possible. Male, upper 30s. Before getting sick I was a very capable, high functioning man who never had any noteworthy mental health issues.

Two years ago I began experiencing persistent "brain fog" which manifested itself as a feeling of lightheadedness and wooziness. I never had had this before in my life. I started seeing different types of doctors, and none could help me or explain what was going on. I was checked for vertigo, Meniere's Disease and abnormal blood sugar levels. All negative (my blood sugar is always between 90 - 120 which is optimal).

One year ago, I went through a traumatic time and I plunged into clinical depression (earlier in my life, other stressful times did not have the same result). Once depression hit me, the brain fog got worse, as did my tinnitus which got louder, and my visual snow which grew more visible in dark and low light conditions. For the past year, I've felt almost as if I've had a lobotomy; like I've lost IQ. It's like my brain is actually struggling to function. I feel a strange pressure inside my skull, like I can actually physically feel sensations of straining inside my brain. My depression is a case of "major depressive disorder with melancholic features", or melancholic depression (Google). Other than the thick brain fog, my depressive symptoms include:

• Near total anhedonia and loss of interest in formerly enjoyable activities.
• Extreme hopelessness; seeing life as pointless.
• Excessive feelings of guilt, inadequacy and regret.
• Frequent crying.
• Mood is noticeably worse in the morning.
• Persistent "ear worms".
• Waking up too early in the morning (terminal insomnia).
• Loss of libido.
• Suicidal ideation.

I started seeing therapists, psychiatrists and neurologists to try to figure out what was going on. Unfortunately, we have only been able to come up with some clues. Neurologist ordered a bunch of scans: three MRIs, an MRA, an EEG, BAER, and VER all came back normal. However, he also ordered SPECT and PET scans which showed abnormal results.

SPECT: "Moderate-severe hypoperfusion in the bilateral medial frontal lobes. There appears to be decreased perfusion to the basal ganglia, as well to the mesial temporal region, left more severe than right. Cerebral cortical perfusion is otherwise homogenous and symmetric in the remainder of the cerebrum."

PET: "There is marked diminished fluoro-2-deoxyglucose (FDG) activity involving the temporal lobes bilaterally, including the anterior temporal lobes. Diminished FDG activity also involves the hippocampal structures. Diminished FDG activity is present involving the anterior aspect of the cingulate gyrus. The posterior aspect of the cingulate gyrus and the precuneus gyrus demonstrate normal activity. There is no significant hypometabolism involving the frontal lobes, which demonstrate symmetric metabolism. This is discordant with the SPECT results. There is normal symmetric activity involving the parietal and occipital lobes. Normal cerebellar activity is present."

The big question that nobody seems to be able to answer is: did brain fog cause my depression, or did the depression cause the brain fog? If the depression caused the brain fog, then why did I have the fog for almost a year before the major depression struck me?

I was prescribed sertraline (Zoloft). I tried it for four days, and it increased my fogginess in a major way. I have tried bupropion (Wellbutrin) a few times, and it does seem to give me a little bump but I'm still far from normal. Interestingly, two medications that give me significant relief are amphetamine (Adderall) and methylphenidate (Ritalin). Adderall in particular almost fully lifts my depression, but after it wears off I return to a depressed state. However, I do not take these regularly, only as needed. Also tried an SNRI called Fetzima, which also made the fog worse but not as bad as Zoloft.
 

I thought I might have Lyme disease, but after multiple negative tests and many months on antibiotics with no improvement, I had to admit that I did not.

 

I have tried to do whatever I can to help myself over this past year, but with little or no progress. I have tried eating a lot better, drinking more water, doing cardio exercise several times a week, meditating several times a week, switched to decaf, sleeping more and forcing myself to engage in outside activities. I have also tried these supplements:

Fish oil
Vitamin D3
Acetyl-L-carnitine
Phosphatidylserine
Multivitamin
COQ10
Magnesium
Zinc

Tryptophan

5HTP

Acetyl-L-tyrosine

I have been through so many tests and had so much blood drawn, it's ridiculous. Almost everything is very normal and optimal, except for:

• Testosterone is low for my age group (around 325; should be over 600).
• FSH and LH keep coming back low.
• Vitamin D3 was low (25; is now in the 35-40 range which is okay).
• Pregnenolone was low (first 26, then less than 5).
• Tested IgG positive for Epstein-Barr Virus and mycoplasma pneumoniae (my infectious disease doctor said not to worry and that this only means that I had EBV and pneumonia some time previously in my life...which is odd because I don't recall ever having mononucleosis or pneumonia. Apparently the majority of people test positive for EBV antibodies).
• Possibly of interest: sometimes (once or twice monthly) I get "visual migraines with aura", where my vision gets all blurry for about 15 minutes. These episodes do not include headaches.

I ordered the "TruBrain" liquid supplement, and all it did was give me a slight headache and increased brain fog. To address the low testosterone, I went on testesterone replacement therapy for a couple months (via injection), but all it did was increase my libido.

I tried rTMS therapy, but after 20 sessions and very little improvement I stopped. I tried three infusions of ketamine which did seem to give me a little boost, but at $450 per session I could not justify continuing.

At this point, I am starting my fourth week of bupropion with some but not much improvement. If I don't see any noteworthy results in the new couple of weeks, I'll have to switch to another one. I am also looking into "deep TMS" which seems to be a little more effective than rTMS. As a very last resort, if I am still suffering like I have been I would be open to undergoing electroconvulsive therapy (ECT)...to save my life.

All over the Web there are people complaining about "brain fog" and looking for answers. It seems like modern medicine does not have any solution for them. I have read and been told that brain fog often accompanies depression, but I can't help but feel that my cognitive impairment and clouding of consciousness are something that's on a whole other level. Before I was depressed, I never had to deal with any of this crap. Why it chose to hit me at age 38 is a mystery that will probably never be solved.

I would be very appreciative of any feedback and suggestions that users of this site could offer. If you know anyone who might have some useful advice to share, please send them my post. Thanks so much.
 

Edited by DarkRiver, 28 May 2017 - 08:29 PM.

[Mind_Paralysis]

Hmm... the visual migraines could be something... perhaps you're experiencing some type of seizure? This could explain why several antidepressants are not effective - they often exacerbate seizures among epileptics, as well as other disorders which are treated with anticonvulsants, such as RLS and PLMD.

 

Interestingly enough, RLS is treated with dopamine-agonists - amphetamine and methylphenidate are indirect dopamine-agonists.

 

Have you ever tried Tianeptine? It's an antidepressant with actual ANTI-convulsant properties, and has a completely different mode of action than SSRI's or SNRI's. Might also be better for anhedonic depression than for anxious depression (you strike me as if you don't have anxious depression).

 

You could also look into Selegiline, which is an MAOI which has some dopaminergic properties as well, since you responded favorably to stimulants.

[jaiho]

http://psychotropica...al-ad-algorithm

 

Follow this.

It's the absolute best treatment for endogenous, or melancholic depression. It requires broad range treatment (SNRIs, TCAs, MAOIs)

Edited by jaiho, 29 May 2017 - 12:39 PM.

[DarkRiver]

Have you ever tried Tianeptine? It's an antidepressant with actual ANTI-convulsant properties, and has a completely different mode of action than SSRI's or SNRI's. Might also be better for anhedonic depression than for anxious depression (you strike me as if you don't have anxious depression).

 

You could also look into Selegiline, which is an MAOI which has some dopaminergic properties as well, since you responded favorably to stimulants.

 

Thanks; I will mention Tianeptine and Selegiline to my psychiatrist.

 

http://psychotropica...al-ad-algorithm

 

Follow this.

It's the absolute best treatment for endogenous, or melancholic depression. It requires broad range treatment (SNRIs, TCAs, MAOIs)

 

That looks promising, however I see that sertraline figures prominently in the Gillman protocol and unfortunately I react very poorly to that drug. As a matter of fact, any drugs or supplements that influence serotonin don't seem to agree with me: sertraline, Fetzima (SNRI), mirtzapine, and 5HTP all seem to increase my brain fog considerably. I don't get this effect whenever I take drugs and supplements that don't touch serotonin, e.g. bupropion, tyrosine, Adderall, Ritalin.

[DarkRiver]

Just to update: still on bupropion 150 mg XL daily. It seems to be helping...to use an analogy, before it was like I was drowning, and now it seems like I have a life vest on, so I'm floating but still stuck in the water.

 

I saw a psychiatrist not long after starting this thread and she wanted to put me on aripiprazole (Abilify). I was going to start taking it, but thankfully I did my research and found out that this drug comes with a considerable rate of tardive dyskinesia, and in many cases the TD does not stop even after you discontinue the medication. So thanks but no thanks, doc.

 

I am going to see my regular psychiatrist soon and I am going to mention notriptyline, tianeptine, selegiline, clomipraline and Parnate (MAOI) to him. I will post back here with my (hopefully very positive) results. In the meantime, I would appreciate any other tips and feedback. Thanks very much.

Edited by DarkRiver, 05 June 2017 - 02:44 PM.

[hdl_1]

Look into NMDA/AMPA modulation. A few of interest: glycine, d-serine, sertraline, NAC, aniracetam, agmatine.
I find that nothing beats the brain fog bețter than the combo above. For glycine/d-serine/sertraline, you don't have to take the dosage usually taken by schizophrenia sufferers, smaller amount will do the job just fine.

Sent from my SM-G850W using Tapatalk

[DarkRiver]

Look into NMDA/AMPA modulation. A few of interest: glycine, d-serine, sertraline, NAC, aniracetam, agmatine.

 

I actually just ordered some NAC today. I can't tolerate sertraline, unfortunately.

 

As for aniracetam, is it similar to piracetam? I'm asking because TruBrain really increases my brain fog, and it contains piracetam. Do you think aniracetam would product a similar effect?

 

I will definitely look into glycine, d-serine and agmatine. Thanks.

[hdl_1]

I meant sarcosine, not sertraline! Auto-correction issues!!

So combo is: sarcosine, d-serine, glycine, NAC, aniracetam and agmatine.

Aniracetam has a different mechanism of action. It desensitizes AMPA receptors. Piracetam seems is acting more on the cholinergic receptors.

Sent from my SM-G850W using Tapatalk

Edited by hdl_1, 06 June 2017 - 12:44 AM.

[FGI]

Hello DarkRiver. I have a theory. You say it happened at a distinct time, two years ago and you had no issues previous. This points to a specific, environmental cause. Taking antidepressants and brain pills will likely be of no help. Think back to what you were doing two years ago, before the fog. 

 

Your symptoms sound like possible heavy metal poisoning. Do you have mercury amalgams in your teeth? Did you get any dental work done around that time?

 

If not, did you have any lifestyle changes? New job, new house, new car, new relationship, anything? ANYTHING strange or out of the ordinary?

 

 

 

 

[Solarium]

Hi,

Very similar symptoms to your own. Sudden onset with woozy feeling, cognitive slowing, and later pretty severe depression. Dopamine agonists in general have been effective with similar worsening due to serotonin agents. First thing I found helpful was selegeline when carefully combined with amphetamine (yes contraindicated, but in my case, the combo was quite benign). After a while, my neck and back began to hurt a lot and I switched to carefully managed parnate from selegeline (30-60mg). This has improved things greatly, although 2 weeks after I dial the parnate below a certain dose, the fog comes back. It's effectiveness seems to have diminished over time, which is concerning. With higher doses, I've found that I become very apathetic/anhedonic. My libido ends up diminishing and I become essentially emotionless. Thus, I am loathe to increase my parnate beyond a certain amount, despite occasional brain fog. This has lead me to search for alternative therapies, but so far, I've had similar results to yours (incl. TMS and ketamine infusions).

I exercise regularly, eat fine, sleep pretty well at this point. Given all this, I find it hard to believe this isn't a sort of organic disorder; particularly since other symptoms of depression are essentially non existant on parnate.

Have you found that your symptoms are progressive, or is it a pretty consistent?

[Deaden]

With real anhedonia, you can't feel sadness. You can't cry even if you force yourself, it's too much of a human emotion. So it is something else

[hydrus]

The big question that nobody seems to be able to answer is: did brain fog cause my depression, or did the depression cause the brain fog? If the depression caused the brain fog, then why did I have the fog for almost a year before the major depression struck me?

 

 

possibly neither. You have an illness which caused brain fog and as it progressed,  depression.

[nothingtoseehere]

..

Edited by nothingtoseehere, 27 August 2017 - 08:27 PM.

[DarkRiver]

Hi,

Very similar symptoms to your own. Sudden onset with woozy feeling, cognitive slowing, and later pretty severe depression. Dopamine agonists in general have been effective with similar worsening due to serotonin agents. First thing I found helpful was selegeline when carefully combined with amphetamine (yes contraindicated, but in my case, the combo was quite benign). After a while, my neck and back began to hurt a lot and I switched to carefully managed parnate from selegeline (30-60mg). This has improved things greatly, although 2 weeks after I dial the parnate below a certain dose, the fog comes back. It's effectiveness seems to have diminished over time, which is concerning. With higher doses, I've found that I become very apathetic/anhedonic. My libido ends up diminishing and I become essentially emotionless. Thus, I am loathe to increase my parnate beyond a certain amount, despite occasional brain fog. This has lead me to search for alternative therapies, but so far, I've had similar results to yours (incl. TMS and ketamine infusions).

I exercise regularly, eat fine, sleep pretty well at this point. Given all this, I find it hard to believe this isn't a sort of organic disorder; particularly since other symptoms of depression are essentially non existant on parnate.

Have you found that your symptoms are progressive, or is it a pretty consistent?

 

Hi Solarium, I am truly sorry to hear about you (and all the others out there) who have come down with this horrific, disabling, debilitating condition. Like me you seem to have run the gamut trying to find treatment to help return to normal. I am cautiously optimistic that I might be inching forward towards recovery. I have had the worst luck with antidepressants, so after the fifth one I swore them off and am now trying to recovery "naturally", meaning I do moderate-intense cardio several times weekly, try to sleep more, get more sun, eat a much improved diet (currently trying to go gluten- and dairy-free), and I'm taking many supplements and vitamins to maximize brain health.
 

I think I may have had a mini-breakthrough the other day. I started taking SAM-E and it does seem to help stabilize my mood. After four days on it, I definitely don't feel great but I have not had any depressive attacks in which I break down, start sobbing like a baby and contemplate ending my life.

 

I have definitely noticed a link between my brain fog and depression. When my brain fog is worse, my mood is noticeably worse (or vice versa...who knows what causes what). I think this brain fog is a result of reduced activity in the frontal lobes, particularly the prefrontal cortex. Many treatment-resistant depressiove patients respond positively to TMS of the left dorsolateral prefrontal cortex.

 

I also wake up every morning with God-awful anxiety, which starts to dissipate as I get up and begin my daily routine.

[xsra]

Hi DarkRiver, 

I feel for you and your struggle. I am in a very similar boat as you, and am also going through the hell that is brain fog, along with depression, visual disturbances, and more. Mine came about likely due to an LSD experience i had 7 years ago. Been to countless doctors and tried a myriad of treatments. I am currently doing deep TMS treatment (on my 22nd session), and so far, nothing significant unfortunately. I still have 17 more sessions left, so I'm going to give it a full shot. Avoiding Abilify was a smart move, as I took that and started having jaw pain and jerky movement of the mouth, and have since discontinued it. It is inspiring to see you going the natural route. A lot of the medications that are prescribed for these kind of things seem to come with so much baggage and side effects that in a lot of cases, you may be better off finding natural treatments. In any case, I wish I could point you in the right direction, but all I can say is that you're definitely not alone. If you ever need to talk, please feel free to reach out. Keep us updated on how you're doing and any insights you may find.  

[DarkRiver]

Keep us updated on how you're doing and any insights you may find.  

 

Thanks for the kind words in your post. Yeah, there have been two new recent developments. First the bad news - on my fourth day of taking SAM-E, I had a major depressive breakdown so I stopped taking that supplement, as it either caused me to crash or didn't do anything to prevent it. Now the good news - I seem to be responding well to 5-HTP! On my fourth day now, and my brain really seems to like the influx of extra serotonin. I'm only taking 100 mg daily, so I'll try to increase it slowly to see if I can get even better results. Note: I did not get such a reaction when I supplemented with L-tryptophan.

 

I also ordered the Fisher Wallace brain stimulator device which should arrive soon. I am praying to God that the combination of 5-HTP and the brain stimulation will cure me or at least get me back to 90% normal.
 

[pbandy1]

KSM-66 perhaps? Although this may just help deal with anxiety, I'm not sure if there are any studies suggesting a benefit for clinical depression.

KSM-66 perhaps? Although this may just help deal with anxiety, I'm not sure if there are any studies suggesting a benefit for clinical depression.

[pbandy1]

Also, you stated that you tried Zoloft only for 4 days. You may need to be patient. It is well known that in the first few weeks you may actually get worsening of symptoms. It may take up to 4 weeks to increase postsynaptic activation for certain serotonin receptors like 5-ht1a, as well as decrease 5-ht2a activation (generally a good thing in terms of depressive symptoms/anxiety).

[Kinesis]

Also, you stated that you tried Zoloft only for 4 days. You may need to be patient. It is well known that in the first few weeks you may actually get worsening of symptoms. It may take up to 4 weeks to increase postsynaptic activation for certain serotonin receptors like 5-ht1a, as well as decrease 5-ht2a activation (generally a good thing in terms of depressive symptoms/anxiety).

That's the first thing that jumped out at me. Every serotonergic antidepressant I've ever tried made me more depressed at first. It takes two to four weeks for the antidepressant effect to kick in. The combination of sertraline and bupropion (Zoloft and Wellbutrin) works really well for a lot of folks, and if the doc prescribed is worth a fair trial before being dismissed.

Sometimes docs start out with too high a dose - mine does - making it really difficult to get through the first few days. Get the doc to start with a lower dose or if they're in divisible (tablet, non-time-release) form cut them in half at first or alternate days; in any case starting out slow can make it a lot easier to acclimate to those meds.

It's worth a try. Often things that make you feel better right away, like amphetamines or benzos or opiates, are the worst candidates for the longer run.

[DarkRiver]

 

 

Also, you stated that you tried Zoloft only for 4 days. You may need to be patient. It is well known that in the first few weeks you may actually get worsening of symptoms. It may take up to 4 weeks to increase postsynaptic activation for certain serotonin receptors like 5-ht1a, as well as decrease 5-ht2a activation (generally a good thing in terms of depressive symptoms/anxiety).

That's the first thing that jumped out at me. Every serotonergic antidepressant I've ever tried made me more depressed at first. It takes two to four weeks for the antidepressant effect to kick in. The combination of sertraline and bupropion (Zoloft and Wellbutrin) works really well for a lot of folks, and if the doc prescribed is worth a fair trial before being dismissed.

Sometimes docs start out with too high a dose - mine does - making it really difficult to get through the first few days. Get the doc to start with a lower dose or if they're in divisible (tablet, non-time-release) form cut them in half at first or alternate days; in any case starting out slow can make it a lot easier to acclimate to those meds.

It's worth a try. Often things that make you feel better right away, like amphetamines or benzos or opiates, are the worst candidates for the longer run.

 

 

That's definitely good advice, but my reaction to sertraline is so strong and unusual that there's no way anyone would take it if they got the same side effects. Whenever I've tried sertraline, it's caused a very strong feeling of pressure behind my forehead, as if my frontal lobes had been flooded with wet cement that was starting to solidify. My thinking also gets even cloudier. So it's not just that the drug makes me feel more depressed than usual, but it also gives me strange neurological symptoms.

 

What's interesting is that according to GeneSight, sertraline is one of the antidepressants that I should not be taking because I am "heterozygous for the short/long promoter polymorphism of the serotonin transporter gene (SLC6A4). The short promoter allele is reported to decrease expression of the serotonin transporter compared to the homozygous long promoter allele. The patient may have a decreased likelihood of response to SSRIs due to the presence of the short form". According to GeneSight, I have a "moderate gene-drug interaction" with Celexa (Citalopram), Lexapro (escitalopram), Paxil (paroxetine), and Zoloft (sertraline).

 

Additionally, when I uploaded my 23andMe raw data to Promethease it came up with a similar finding.

 

7x less likely to respond to certain antidepressants

• Citalopram
• Paroxetine
• Venlafaxine
• Amitriptyline
• Escitalopram