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End of my tether? General med questions (long-ish)

Posted by kreedi on June 24, 2002, at 8:19:25

Month 7 of current (major) depressive episode. Beginning to feel "treatment refractory"; beginning to lose hope.

New psychiatrist, one I'm actually comfortable with, and who seems to know his stuff. (I live in India.) Just finished two weeks on Effexor XR -- week 1 on 37.5, week 2 on 75 mg. Will go up to 112.5 from tomorrow. No response so far. No bad side effect except major ejaculatory delay (which, I'm assuming, will only worsen as the dose goes up).

I seem to have responded to Prozac in the past, 20 mg. Have been on it for two significant periods of time in the past (in 1995 and 1997-98), and at least two more times for a few weeks. The delayed ejaculation was always there (but I could live with it).

The new pdoc suggested (i) going back on Prozac, (ii) Effexor XR, and (iii) Serzone. I chose the second option since I was worried that the Prozac might not be effective the third or fourth time round and because I'd read that Serzone wasn't that effective an AD.

Sertraline: complete anorgasmia, partial impotence. Paxil: anorgasmia. Celexa: was on it for nearly three months recently, going up from 10 mg to 40 mg -- no response. Remeron: excessive sedation (I'm very sensitive to antihistamines), which I think will not go even at doses like 45 mg. Also, alcohol would worsen the sedation problem. Wellbutrin: insomnia and weight loss, even on 150 mg. I'm very skinny, usually no more than 118 lbs, and I'm down to 108 lbs. 29 years old, male. (There's more to the meds history, but enough for now.)

In short, I don't know what to do, I feel I'm at the end of my metaphorical tether. Any response would be appreciated, but my specific questions are these: (i) If the Effexor doesn't work, and it doesn't feel like it's going to, should I simply go back to fluoxetine? Not worry about theoretical "poop-out" or that the nature of my depression has changed and so won't respond to Prozac? What are the studies on this? Or people's "anecdotal" experiences about multiple try-outs of the same drug? (ii) Augmenting -- effectiveness and safety of pindolol? Anything else that works well with venlafaxine or fluoxetine? (iii) Any other combinations: Remeron + Wellbutrin, for instance -- do the side effects cancel each other out? (iv) Worth trying Nardil (my pdoc seems reluctant)?

Thanks,
Kreedi (aka Jay)


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poster:kreedi thread:110602
URL: http://www.dr-bob.org/babble/20020617/msgs/110602.html