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Re: SSRI vs SNRI - Efficacy Comparison Article (lo » SLS

Posted by Tony P on March 16, 2010, at 17:54:01

In reply to Re: SSRI vs SNRI - Efficacy Comparison Article (lo, posted by SLS on March 8, 2010, at 6:27:14

Interesting article -- thank you Scott for posting it -- both for the meta-study aspects and the insight into the differences between specific ADs.

As a couple of posters have commented, the balance between the three main neurotransmitters seems to be critical, and different for each person. I am quite sure from my own experience & talking to several pdocs that "YMMV" is the one true generalization one can make about antidepressants. Until recently DA was the "Cinderella" of the three, perhaps because of fear of its association with cocaine and other addictive drugs.

The most effective combination for me has been an SNRI and "stimulants" that boost NE & DA. My current regime is:
- 60 mg Cymbalta / day
- 20 mg Lexapro (Cipralex)
- 100-200 mg modafinil (Provigil/Alertec)
- 30 mg Buspar
and
- coffee, 2 cups (large & strong) <g>

As I was suffering extreme hypersomnia (sleeping 18 hr/day for days at a time) on previous regimes, the modafinil has been a godsend (getting rid of the Remeron helped too).

On the subject of stress and its effect on depression, I heartily agree with the previous posters who remarked:

>> Stress and/or unhappiness in its self causes a chemical imbalance in the body, and perhaps medications that block that response could be another way to mitigate symptoms.

>That is wonderfully insightful. Hopefully, we will soon learn enough to be able to turn specific genes on and off.
> - Scott

I experienced this very directly when I was working in a high-stress job and on Serzone alone as an AD. The Serzone worked well except for those days when I came home stressed out and fell quickly into a reactive depression. At risk of beating once more a drum I beat often on these pages, Buspar (buspirone) has a subtle but significant effect on this for me. It reduces the anger and depression from stress, and has a small but noticeable activating effect. It either only works for about 1 person in 5, or its effects are so much less dramatic than the major ADs, that it has had a bad press; all I know is, it works for me.

And (although it probably belongs on the "Alternative" board), I can't resist once again mentioning coffee. I don't drink it after noon as a rule, but 2 strong cups in the morning makes a huge difference to my day.

- Tony


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poster:Tony P thread:844518
URL: http://www.dr-bob.org/babble/20100305/msgs/939739.html