Posted by Racer on May 3, 2007, at 12:01:47
In reply to Do antidepressants work ?, posted by jenny80 on May 2, 2007, at 19:19:53
> I am beginning to think that these medications have no effect what so ever on depression.
> May be i feel this way because i have never felt any response to them?My guess is that you're feeling this way because you're depressed, and depression comes with that sort of negative thinking by its very nature. It's hard to believe, when you feel that bad, that ANYTHING will EVER make any difference.
Anti-depressants do affect depression. I think a big part of the problem is that there is no way to say, "ah, this sort of depression is caused by [x], so we can treat it with [a]." It's all a matter of trial and error, and that can be particularly hard with antidepressants.
The first problem is that the benefits aren't apparent for weeks, or even months. During that time, there are a lot of adverse effects, which can lead to early discontinuation of a trial. Bottom line -- a lot of people don't respond to antidepressants because they give up too soon, before the medications have a chance to work. Many of the start up effects go away in a few weeks, or a couple of months. What you experience when you first start a medication is not what you'll experience farther down the line.
It's hard, though, when you're depressed, and feeling pretty punk from the side effects, and not yet getting any benefit from the drugs. It's easier to say they won't work, and stop them. I know this, because I've done it. But if you can stick it out, it's often possible to feel pretty normal again -- just a question of riding that Medication-Go-Round a little longer.
> Never the less I am trying to decide which would be best for me.
> I have tried most of the SSRI's and could not tolerate the MAOIs. Do you think I may benefit from a more noradrenergic antidepressant or may be RIMA or tricyclic. What would you recommend for me ?
> j xHere's your list from your other post:
>Citalopram 3 months at i think 20 mg od.
>Venlafaxine 225 mg 2 years
>mirtazapine 15 mg 4 weeks
>Fluoextine 20 mg 4 weeks
>escitalopram 10 mg 6 weeks with lamotrigine 100 mg
>nardil 15 mg tds and parnate 10 mg tds both only 2 weeksI see three SSRIs, to for less than the period I'd expect to see any improvement, and one at the minimum dose. Personally, before trying any of the TCAs, I'd try another SSRI trial, and probably add an augmenting agent. I'm biased in favor of either Zoloft or Prozac myself, but you also have the option of trying Paxil (which I don't recommend), or more extensive trials of Celexa or Lexapro. A lot of people get great results from Lexapro, and it seems to be the SSRI of choice for a lot of pdocs. Again, though, I like Prozac and Zoloft myself -- because I've had the best results from them.
You didn't mention what sorts of problems you've had with medicatiosn in the past, other than not responding. Sometimes specific side effect profiles can help a lot in trying to figure out what might be a good drug to try next.
I know you said that Effexor didn't help, but I can't believe you stayed on it for two years with NO response of ANY kind. What did it do?
Also, what does your depression look like? Are you one who wakens early? Or hypersomnolent? Leaden paralysis? Or staring at the walls? Anhedonia? Can you react when something positive happens? That sort of symptomology also helps with figuring out medications to try.
I think in one of your earlier posts you mentioned bulimic behavior? Is that completely gone? If so, and if it's been long enough, and you're willing to take a bit of a risk, Wellbutrin XL is often a very good augmenting agent with SSRIs. It's also a pretty friendly drug, in terms of side effects, although it is activating, so may increase anxiety. It can also cause headaches.
I can think of a bunch of options, but before I try to list them, it would really help to know more about your symptoms, and what effects -- beneficial or adverse -- you've had from the drugs you've tried. Some of what I'm thinking about would be great if you have symptom group A, but a fiasco for symptom group B, you know?
Good luck.
poster:Racer
thread:755317
URL: http://www.dr-bob.org/babble/20070502/msgs/755509.html