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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by sl on May 14, 2001, at 18:51:37
Okay. I've been doing some research trying to pinpoint which chemicals I have problems with and why certain drugs don't work. What I've found is that Doctors seem to want to KEEP trying to treat me with SSRI's, but they don't WORK!
Can someone give me a list of NON-SSRI Antidepressants to try? I had good success on Wellbutrin, but I seem to have faded out over the years. I'm on Effexor now, it's barely keeping my head above water, and I don't know where to turn next.
sl
Posted by SalArmy4me on May 14, 2001, at 21:17:42
In reply to NON-SSRI Antidepressants?, posted by sl on May 14, 2001, at 18:51:37
Remeron (Mirtazapine) - a noradrenergic and specific serotonergic antidepressant (NaSSA). It is excellent for sleep architecture and anxiety relief. It has no nausea, no GI problems, no sexual dysfunction, and requires no blood tests.
Serzone (Nefazodone) - this SARI acts by blockade of serotonin 2A receptors, combined with less potent serotonin reuptake inhibitor (SRI) actions. Net antagonism at the 5HT2A receptors means that nefazodone theoretically lacks the potential to cause sexual dysfunction, insomnia, and anxiety, associated with the SSRI's.
Norpramin (Desipramine) - Both the weaker serotonin reuptake portion and the stronger norepinephrine-reuptake portion of this Tricyclic drug act synergicistially to cause a very effective antidepressant effect. Clinical lore and the PDR suggest that this 2nd generation tricyclic has less sedation, weight gain, or sexual dysfunction than the other 1st generation' tricyclics.
Posted by JohnL on May 15, 2001, at 5:28:02
In reply to NON-SSRI Antidepressants?, posted by sl on May 14, 2001, at 18:51:37
> Okay. I've been doing some research trying to pinpoint which chemicals I have problems with and why certain drugs don't work. What I've found is that Doctors seem to want to KEEP trying to treat me with SSRI's, but they don't WORK!
>
> Can someone give me a list of NON-SSRI Antidepressants to try? I had good success on Wellbutrin, but I seem to have faded out over the years. I'm on Effexor now, it's barely keeping my head above water, and I don't know where to turn next.
>
> slSL,
My favorite approach in situations like yours is to choose your favorite SSRI, whichever one you tolerate the best, regardless of how well or how poor it works, and add Zyprexa, Risperdal, or Amisulpride to it. Another good turbocharger for SSRIs is Adrafinil. I think good results are available with combinations of any of these. I do not like the idea of continuing with antidepressants alone when several of them have already been disappointing. Unfortunately, mainstream practitioners tend to stay within the antidepressant category way to long, in my opinion. Sure, one of them could turn out to be magical, but I think the magic is more quickly reached when other drugs are used, such as the antipsychotics and stimulants. And in my book, the quicker good results are achieved, the better.If you do want to keep trying more antidepressants, Desipramine or Nortriptyline could be good choices, since they have mechanisms on other circuits besides just serotonin. Try both, because one may work where the other doesn't. But again, I think good results are more likely when one looks in the antipsychotic category and/or the stimulant category instead. I know it sounds strange, but APS and stims can be a lot better at treating depression than the antidepressants. Disclaimer though...these are just my opinions, my observations, and my experience.
John
Posted by roo on May 15, 2001, at 9:51:45
In reply to Re: NON-SSRI Antidepressants?, posted by JohnL on May 15, 2001, at 5:28:02
John,
I do well on prozac as well, but unfortunately get
the sexual side effect (the negative one). I only
take 20 mg's. I tried taking a lower dose (15 mg's)
and felt myself getting depressed again. Tell me a little
more about the zyprexa and adanafril (I know I'm not
spelling these right). Would taking them allow a
smaller dose of prozac? Do you have any suggestions
for a person that tends to do WELL on the SSRI's and
nothing else that would allow them to take a smaller
dose? I'm really searching and have been for a long'
time...help....
Posted by jodsteroo on May 15, 2001, at 13:28:04
In reply to Re: NON-SSRI Antidepressants?, posted by JohnL on May 15, 2001, at 5:28:02
john- ssri's hit serotonin(paxil,prozac,zoloft,celexa,luvox..)wellbutrin hits dopamine and effexor/serzone/remeron/trycyclics(older ad's) hit both norepinephrine and serotonin. effexor at high doses targets dopamine.the maoi's(where you cant eat aged foods)target all three neurotransmitters.it sounds to me that since you had success with wellbutrin in the past something more stimulating would suit you...you could raise your effexor dose...try serzone /remeron or older ad'slike desipramine or protryptaline(allthough there very sedating because they affect other neurotransmitters like h1 ect...but good for anyiety if you have that prob.)or you could try wellbutrin or ritalin(hits dopamine) with a low dose ssri...that might kick it back into gear. you could always try an maoi like parnate but then youve got the food issue... also..it would help me out alot in my suggestions if i knew all your symptomes ae: are you anxious,tired? do you have insomnia? be sure and tell your doc any other symptomes your having so he can determine the best ad out there for you cause theres a ton to choose from.ask your doc about some of these ideas...hope this helps!
Posted by sl on May 15, 2001, at 17:58:44
In reply to Re: NON-SSRI Antidepressants?, posted by JohnL on May 15, 2001, at 5:28:02
years. I'm on Effexor now, it's barely keeping my head above water, and I don't know where to turn next.
> >
> > sl
>
> SL,
> My favorite approach in situations like yours is to choose your favorite SSRI, whichever one you tolerate the best, regardless of how well or how poor it works, and add Zyprexa, Risperdal, or Amisulpride to it. Another good turbocharger for SSRIs is Adrafinil. I think good results are available with combinations of any of these. I do not like the idea of continuing with antidepressants alone when several of them have already been disappointing. Unfortunately,But...I don't understand. Why would I continue ineffective stuff and combine it...? Instead of just looking for something that'd be effective alone? It seems to me that if eating one rock doesn't help, eating three rocks isn't going to help either, y'know? ;)
The ones that were disappointing were all SSRIs by the way. The other stuff...it seems the LESS it has to do with Seratonin, the better it is. Wellbutrin has nothing to do with Seratonin, and it worked great. Effexor has some to do with Seratonin and some to do with other chemicals, and it works OKAY. See what I mean? So it seems to me that if I can figure out what KIND of ADs should be working, I should try them.>mainstream practitioners tend to stay within the antidepressant category way to long, in my
opinion. Sure, one of them could turn out to beThe other thing is that I'm not using a psychiatrist. I can't afford it. I'm using my regular internist. She's wonderful about me never having money. And like I've mentioned in other threads, I think she's wonderful. If nothing else, all her info is current cuz she or her nurse look most of it up when I ask. :)
>magical, but I think the magic is more quickly
My reaction to Wellbutrin was nearly magical. I really got spoiled with that.
>reached when other drugs are used, such as the antipsychotics and stimulants. And in my book, the quicker good results are achieved, the better.
Oh, absolutely.
If I can't find one that's successful, I'm going to try either Remeron, or go back to a lower dose of Effexor and add Ritalin. But I'd REALLY rather keep the number of possible drug interactions to a minimum, y'know??> If you do want to keep trying more antidepressants, Desipramine or Nortriptyline
Ta-DAH! That's what my Dr thought too. ;)
I'll be starting Nortriptyline sometime this wkend. I'll keep Desipramine in mind for if this fails. ;)>could be good choices, since they have mechanisms on other circuits besides just serotonin. Try both, because one may work where the other doesn't. But again, I think good results are more likely when one looks in the antipsychotic category and/or the stimulant category instead. I know it sounds strange, but APS and stims can be a lot better at treating depression than the antidepressants. Disclaimer though...these are just my opinions, my observations, and my experience.
Which was EXACTLY what I was looking for!
thanks so much!
I wish I had a printer so I could print this out. :/sl
Posted by medlib on May 15, 2001, at 18:25:19
In reply to Re: NON-SSRI Antidepressants?, posted by JohnL on May 15, 2001, at 5:28:02
SL--
My pdoc says that Effexor affects NE reuptake significantly at doses above 200mg. and DE (weakly), above 300mg. Once you reach your optimum level of Effexor, if you feel something more is needed, you might consider "adding back" a small amount of Wellbutrin. Since Wellbutrin may affect NE and DE receptors in a manner other than reuptake, the combo (W + E) may be more than the sum of its parts. Obviously the usual caveats apply--go slow, check with your pdoc, YMMV; but a few Babblers have found success with that combo, I believe. You could check the Archives, if interested. Few people here find adequate relief with a single med; many of us require 3 or more to get back to ground zero.
Well wishes---medlib
Posted by sl on May 16, 2001, at 7:30:18
In reply to Re: NON-SSRI Antidepressants?, posted by medlib on May 15, 2001, at 18:25:19
> SL--
>
> My pdoc says that Effexor affects NE reuptakeNO WAY I'm trying that. At 150mg I'm tired ALL the time and it's bad. I can't be like that.
>significantly at doses above 200mg. and DE (weakly), above 300mg.
I can't even imagine. If 150mg is making me like this, 300mg...well, I might never know what effect it has on me, I might never wake up long enuf to find out!
>Once you reach your optimum level of Effexor, if you feel something more is needed, you might consider "adding back" a small amount of Wellbutrin. Since Wellbutrin may affect NE and DE receptors in a manner other than reuptake, the combo (W + E) may be more than the sum of its parts. Obviously the usual caveats apply--go slow, check with your pdoc, YMMV; but a few Babblers have found success with that combo, I believe. You could check the Archives, if interested. Few people here find adequate relief with a single med; many of us require 3 or more to get back to ground zero.
Yes. I'll sorta file this one away in my mind for "if the Nortriptyline fails".
Again, I wish for a printer so I could save these things. :/
sl
Posted by sl on May 16, 2001, at 21:10:09
In reply to Re: NON-SSRI Antidepressants?, posted by sl on May 15, 2001, at 17:58:44
> > If you do want to keep trying more antidepressants, Desipramine or Nortriptyline
> Ta-DAH! That's what my Dr thought too. ;)
> I'll be starting Nortriptyline sometime this wkend. I'll keep Desipramine in mind for if this fails. ;)by the way, I've got to get OFF the effexor before I can try the Nortriptyline, so says my Dr. And I've heard so many nasty stories I'm going to ASSUME it'll take at least a week or two to get off the Effexor XR. Meanwhile, I'm trying SAM-e, and I'll report back on the effects. :)
sl
Posted by medlib on May 17, 2001, at 13:36:42
In reply to Re: NON-SSRI Antidepressants?, posted by sl on May 16, 2001, at 7:30:18
>If 150mg is making me like this, 300mg...well, I might never know what effect it has on me, I might never wake up long enuf to find out!SL---
- Some people feel sedated on *all* meds which primarily affect serotonin (some, only initially; others, indefinitely).
- A few psychoactive meds have quite different effects at higher doses than they do at lower ones; for these drugs, "more" is *not* "more of the same." Remeron is one example: at low doses, it is sedating and appetite-stimulating; at higher levels, it is much *less* appetite-stimulating and somewhat less sedating. Effexor is another; at higher doses most people find it is stimulating, not sedating, and it frequently causes insomnia.
- Effexor is frequently a b-tch to discontinue. My (obviously, poorly made) point was that, if you are still on Effexor, and if it is at all mood-elevating for you, it might be worth going up before you go off. Nearly all meds have side effects, but those of high-dose Effexor are different and may be more tolerable to you.
Re: no printer. Are you aware of your other options?
- You could save the relevant URLs to a desktop folder for easy retrieval and/or subsequent printing.
- You could copy/paste relevant passages from posts to a previously opened Word file by alt+tabbing between open screens. (I add the poster's name and a line btween posts.) The resulting Word document can be saved to a floppy and printed at your local public library for 10 cents/page.Good luck on your research and med trials--medlib
Posted by sl on May 17, 2001, at 15:18:38
In reply to PS--Sometimes more ...isn't » sl, posted by medlib on May 17, 2001, at 13:36:42
> >If 150mg is making me like this, 300mg...well, I might never know what effect it has on me, I might never wake up long enuf to find out!
> - Some people feel sedated on *all* meds which primarily affect serotonin (some, only initially; others, indefinitely).That might just be me. I don't remember Prozac having that effect, but i tried it in like 1994 and I might just be forgetting.
> - A few psychoactive meds have quite different effects at higher doses than they do at lower ones; for these drugs, "more" is *not* "more of the same." Remeron is one example: at low doses, it is sedating and appetite-stimulating; at higher levels, it is much *less* appetite-stimulating and somewhat less sedating. Effexor is another; at higher doses most people find it is stimulating, not sedating, and it frequently causes insomnia.The other things about Effexor, tho....my fear of not having money and having severe withdrawal symptoms, that thing with the "tardive diskinesia" as a long-term effect...those are big deterrents to trying it for longer anyway. If I'd known about those I would have resisted ever trying it. I need something I could comfortably stay on forever. :/
> - Effexor is frequently a b-tch to discontinue. My (obviously, poorly made) point was that, if you are still on Effexor, and if it is at all mood-elevating for you, it might be worth going up before you go off. Nearly all meds have side effects, but those of high-dose Effexor are different and may be more tolerable to you.
I'm tapering off fairly quick. It really wasn't actually helping my depression much at all, and I was having almost MORE problems cuz of being frustrated at all the stuff I couldn't get done cuz of the Effexor-induced exhaustion.
Anyway, I was only on it for about 5 weeks. So I'm tapering off fairly quick, and testing out Sam-E meanwhile. :)
> Re: no printer. Are you aware of your other options?Yup. I'm going to have to start doing all that stuff, I'm learning so MUCH stuff on here I'll start getting it confused. I've got several options already for if this new stuff fails, I'll add "high-dose Effexor" to the list. ;)
> Good luck on your research and med trials
Thanks a lot! :)
Posted by JohnL on May 18, 2001, at 3:53:47
In reply to Re: NON-SSRI Antidepressants?TO JOHN L, posted by roo on May 15, 2001, at 9:51:45
These other drugs could possibly allow you to take a lower dose of Prozac. It is also interesting that anecdotal evidence suggests that Zyprexa may be helpful for sexual function. Based on my own experience, I would agree with that. Adrafinil on the other hand can worsen sexual function. I have found though that Zyprexa completely reversed my sexual dysfunction.
John> John,
>
> I do well on prozac as well, but unfortunately get
> the sexual side effect (the negative one). I only
> take 20 mg's. I tried taking a lower dose (15 mg's)
> and felt myself getting depressed again. Tell me a little
> more about the zyprexa and adanafril (I know I'm not
> spelling these right). Would taking them allow a
> smaller dose of prozac? Do you have any suggestions
> for a person that tends to do WELL on the SSRI's and
> nothing else that would allow them to take a smaller
> dose? I'm really searching and have been for a long'
> time...help....
This is the end of the thread.
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