Posted by jrbecker on March 6, 2003, at 19:29:56
In reply to Re: Is Gepirone the magic bullet for Atypical Dep.? » jrbecker, posted by Jack Smith on March 5, 2003, at 18:19:30
> Was curious about what drug you are on now?
Currently on Celexa 20mg (my indiv. experience rates it higher than Lex), with augmentation of DHEA (or sometime Pregnenolone instead).
>You said previously that you had a "good run" with effexor.
Yes, while taking effexor, it was probably the most "productive" time of my life. Was running marathons, getting cum laude grades at an ivy league school, and being highly social.
>Did it "poop out?"
No, not at all. It's just that I had issues with the side effects that made me feel it might be right to try a straight SSRI again. The side effects for me included: excitability, increased BP, slight dysphoria, tiredness at times, and anorgasmia. Although I am an atypical depressive (associated with low cortisol output), I fit more into the model of a PTSD sufferer (low cortisol but high peripheral aderenaline). In terms of the Effexor, this means that it was a great help to my "mental" anxiety and depression, but was not a good match for my active "flight or flight" jumpiness of already-high sympathetic output.
At the time I decided to give it up, I was in a very stressful job (working 11 hour days) after having recently moved to NYC. I did not feel I needed the extra stimulation brought on by the NARI component of the drug. A move to celexa proved to be a little more my speed.
In genreal, I believe Effexor to probably be the best monotherapy agent among the newer antidepressants. However, it's definitely not right for everyone.
>I am currently about to make a decision between effexor and Parnate/Nardil for my own atypical depression. Would you recommend a trail of effexor first?
It seems rational to try the Effexor first. In terms of motivation, it will give you a lot more energy, although there might be sometimes where you'll feel tired. In terms of treating anhedonia [which is my own biggest issue], Effexor ranks probably higher than any SSRI by itself, but is still outmatched by MAOIs. Bottom line, if I was in your place, I'd allow myself a 6-8 week trial of Effexor before I went the way of the MAOIs. Just my view on it.
>I have taken Celexa which worked great until a poopout and the only other drugs I have given an adequate trial to are Paxil (worked ok but sedated the hell out of me) and WB (OK augmentor of Celexa but didn't get me back to a remission.)
> Any advice for a fellow atypical? (Also have GAD which can be pretty prominent.)
As for the GAD component, Effexor is great. It made me highly social and productive. So don't confuse my "physical anxiety" with GAD, these are quite different. Worrying was not as much an issue as was the excitability factor for me.
Of course, another consideration might be the celexa again, but added to Strattera -- something of a similar effect of what you'll find from effexor.
Hope this was useful feedback. Good luck.