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Re: no luck with Emsam... what next?

Posted by Racer on January 30, 2008, at 22:58:11

In reply to no luck with Emsam... what next?, posted by PsychJ on January 30, 2008, at 18:41:14

First of all, the STAR*D study showed that many of those patients who achieved remission did so after eight weeks or more at an adequate dose. It might be worth sticking it out a bit longer, until you can discuss it with your pdoc... (When you have trouble finding something to work, it's hard to stick it out -- but if something might work if you do stick it out a bit longer, it might be worth it, right?)

So far, you've tried medications from two and a half classes -- I'm counting EMSAM as half an MAOI, just because it's a little different from the conventional, oral MAOIs. Effexor and Cymbalta target both serotonin and norepinephrine. Sometimes that combination is more helpful than the SSRIs, which only target serotonin. Buspar is a whole different animal, and is not an antidepressant.

There are two different classes of antidepressant that you haven't tried -- TCAs and MAOIs -- and a number of kinda random antidepressants, only children, if you will. Which one would work best for you depends on your specific symptoms -- some are better for melancholic depression, others for atypical depression -- which is actually the most common type -- others help more for depression combined with anxiety. Nearly all of them will take at least four to six weeks to kick in -- probably eight weeks or more to get full benefit.

For depression and anxiety, a lot of people have had good luck with Nardil, which I haven't tried. It comes with some side effects, which you may or may not be willing to deal with. Another option is Remeron, which is helpful for a lot of people. Wellbutrin is more activating, but a lot of people find that it's not enough on its own -- it needs something to augment it.

It's hard for me to make anything like a real suggestion, because I don't know what your experience was with the various drugs you've tried. It's clear that they didn't work, but did you have any effect whatsoever? Adverse effects? Mild benefits? Anything at all that might offer a direction to go from here?

Also, it might be worth trying some combinations -- add Lamictal to an antidepressant that maybe thought about helping a little bit; combine Wellbutrin with Zoloft; Remeron and Effexor; there are a lot of combinations that can be very helpful.

I'm sorry I can't offer anything more helpful.


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Psycho-Babble Medication | Framed

poster:Racer thread:809787
URL: http://www.dr-bob.org/babble/20080124/msgs/809838.html