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Re: PS: A look at the side effects scares me more

Posted by Toby on August 26, 1998, at 16:00:53

In reply to PS: A look at the side effects scares me more, posted by Racer on August 26, 1998, at 1:08:49

Oddly enough, ketoconazole has been used to treat major depression at doses of 400 mg per day (need blood tests to monitor liver function, though). I can't find any interactions between it and Serzone.
Pros of Serzone: Almost no anxiety, nervousness or insomnia side effects, no sexual side effects, low risk of inducing mania, OK in kidney or liver diseases. Cons: Some drowsiness initially, some folks get dry mouth and nausea at first which tends to go away in about 2 weeks. The risk of lowered heart rate and hypotension is clinically about 5% greater than placebo (so basically most people don't get it).
Sounds like you've been on multiple drugs without much effect and the doses were pretty high. If your metabolism is the culprit, you may do better with a combination of medications rather than trying to max out just one. Here are some suggestions: Pindolol 2.5-5 mg three times a day added to any antidepressant you are taking; Remeron 15-60 mg added to any antidepressant you are taking; switch to a different class of medication than before like a tricyclic antidepressant (imipramine or nortriptyline) or a MAOI (Nardil); add Buspar 15-60 mg per day to the antidepressant you are taking; add Wellbutrin to any antidepressant you are taking (other than an MAOI); check your thyroid to make sure you aren't borderline hypothyroid and get that treated; adding Revia 25 mg per day to an antidepressant (Revia is a medication to take away cravings for alcohol and opiates, but it is reported to be quite miraculous in relieving resistant depression); an unusual report of Pavabid (Papaverine) 600 mg added to an antidepressant worked; adding a stimulant such as Ritalin or Dexadrine to an antidepressant.
I wrote those in the order that I would try them. In my personal experience I have seen Pindolol work absolutely great and especially with Serzone I have seen hugely great results. Buspar is also quite effective. People don't like to hear about it, but ECT is also an option that doesn't involve ongoing medication side effects, is safe and QUICKLY effective (if I understand you correctly about the suicidal thinking, you don't want to wait much longer on medications to work). I don't know if your particular medical condition makes that feasible. Other "heroic combos" include: Effexor + SSRI, Effexor + Wellbutrin, Serzone + Wellbutrin, or Remeron 45 mg + Effexor 300 mg (which Stephen Stahl, MD depresion guru endorses).
I don't know about your doctor. Is she new to you or have you been with her for awhile? From your previous statement about her reading your chart, it sounds like you are new to the county system or she is new to you. I hope she IS paying attention to you (and I hope you are asserting yourself as best you can about your concerns and questions -- she can't tell you what you don't ask) but that's hard to tell because, honestly, if a person doesn't respond quickly to the first few antidepressants that are tried, it's a matter of just picking some combinations out of a hat to see if your chemistry will respond and to rely on what we hear has worked well for other people. There is no test yet that we can do to determine what specific chemical need a person has so that we can pick a medicine that fits that need. That's coming, but not soon enough for those who are suffering through multiple medication trials now. Nonetheless, don't give up and if you aren't being heard by your doctor, don't dawdle with her -- ask for another doctor. Good ones are out there, even in the county system. I'm a county doc and a good one from what my patients say. That's why I AM a county doc -- because there are alot of bad ones and uninsured folks need just as effective treatment as insured ones. So DON'T give up and DON'T kill yourself. Find a local mental health support group and go to it; there's a lot of good info you can pick up from other patients there in regard to medications, doctors, and other strategies to get rid of the depression. Take your medicine, MAKE yourself exercise and eat right (yes it's hard; yes you have to MAKE yourself do it), and keep all your doctor's and therapy appointments. Good luck.




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