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Re: Depression systematic treatment » nephron

Posted by Sad Panda on May 2, 2004, at 14:14:36

In reply to Depression systematic treatment, posted by nephron on May 2, 2004, at 7:15:57

> My pdoc says that there's an evidence-based systematic method of treating depression pharmalogically (to complement therapy stuff)...
>
> SSRIs- so Paxil or Cipralex or what have you- try 2 or 3- if these don't work move to
>
> SNRIs- for example Effexor, then
>
> Tricyclics: for example impiramine, then
>
> Selective reversible MAOIs- e.g. moclobemide.
>
> If none of these work well enough, pick the one which worked best with the least side effects, and add a mood stabiliser like lithium.
>
> Any feedback on this?
>
> Thanks, Sarah
>
>

Hi Sarah,

> SSRIs- so Paxil or Cipralex or what have you- try 2 or 3- if these don't work move
>

Paxil is the last of the SSRI's to try due to it having the worst side effects & being difficult to withdrawl from. Zoloft is a good first try because it's the safest & has the best track record of the SSRI's, Lexapro seems like it's worth a go too as it seems to be gathering postive users. Prozac is worth a go because it's easy to give up.

> SNRIs- for example Effexor, then
>

Effexor dragged me out of a deep hole, so I am fond of it.

> Tricyclics: for example impiramine, then
>

Not Imipramine. Clomipramine & Amitriptyline are the two TCA's with the best record, side effects probably aren't much worse than SSRI's, just different. Nortriptyline & Desipramine have their uses too, they can add energy to an SSRI that is working & they are usefull to some ADD people like Strattera is.

> Selective reversible MAOIs- e.g. moclobemide.
>

I agree with Scott 110%. Moclobemide is pretty useless for the majority of people, but maybe the thing for someone who has tried everything else.

Similar are Wellbutrin, Remeron & Trazodone, they are pretty weak for most people, but can be a great add on to SSRI's or Effexor as something that counters side effects, i.e. Wellbutrin can rid people of SSRI induced apathy or increase libido. I take Remeron with Effexor & have found it gives great sleep as well as rids me of nausea and anorgasmia problems caused by Effexor.

The irreversible MAOI's Nardil & Parnate are possibly the best AD's that feature the least side effects, but you have to watch what you eat & what drugs you take with them. Sadly these two seem to be the last resort, even though they could be possibly first choice. Given a choice, I would cut to the chase & go directly to Parnate for my symptoms knowing what I know now.

Cheers,
Panda.



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poster:Sad Panda thread:342407
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