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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Dr. Bob on July 10, 2001, at 9:45:34
[from http://www.dr-bob.org/babble/tele/20010601/msgs/46.html]
> Hi
> I'm new to these pages and want some advice. I have what I think is called reactive depression. I've been through a few mega-traumas and upheavals in the past few years. I've coped, but if I get a bit extra on my plate, (nearly always workplace stress)
> I get a visit from the "Black Dog".
> Last year, the wading through treacle effect of the black dog got too much, so I went to see my GP. She prescribed Prozac...this gave me panic attacks and anxiety, so I changed it to Paxil after about three weeks. The Paxil was OK, but I could only tolerate half a tab, or else I got sick. It gave me headaches, but took away the depression. I found I became very foggy mentally after a while and my memory wasn't what it should have been. I came off the Paxil quickly (the withdrawal was horrendous!!!!) and managed medication free for a few months. Then stress at work and bang! the black dog came back. This time I got put on amytriptyline. This made me sleep......boy, did it make me sleep! This was lovely for a start, but I've become fed up of feeling sleepy all day, craving sugary foods and piling on the weight. Before the amytrip. I enjoyed physical activity, but my drive to do this (and diet!) has vanished.
> I went to see the Dr. today, and it was the same idiot that diagnosed my daughter as having flu, when in fact it was a virus that killed her two days later. Needless to say, my confidence in him is not
> exactly..err...great.
> I'd done some research and said I wanted to come off amitrip. and try either Reboxetine or Venlafaxine. He said that he wouldn't prescribe those and all he would give me was Lofepramine.
> I asked why and he said that the others were "too expensive" and "where did I find out about them anyway?" When i said the Internet,I got such a black look!
> I wanted to know about coming off amytriptyline and withdrawal symptoms. He wouldn't (couldn't?) tell me and said to go straight onto Lofepramine.
> I left, clutching my prescription, which I haven't had filled. I have decided to come off the amytrip. and try St. Johns Wort. I'm going to see a herbalist on Friday about this....needless to say, I'm worried whether the advice I get will be valid.
> So, HELP! Can someone tell me -
> How to come off amitrip and wot the side effects will be. I'm going to try half a pill every three days - is that OK?
> Is Lofepramine any good and will it turn me into a half asleep Zombie like amitrip?
> How long will I have to wait before starting the SJW?
> Is the SJW any good for reactive depression?
> Wot is good for this type of depression if SJW isn't, so I can go and see a (different!!!!) GP about it.
>
> Sorry about the rambling,
>
> Vixis.
Posted by tina on July 10, 2001, at 11:49:29
In reply to Redirected: Advice wanted for newcomer, posted by Dr. Bob on July 10, 2001, at 9:45:34
You need a new doctor. This person sounds like a control freak. Doesn't want you to educate yourself about meds on the internet? I can understand the apprehension surrounding the internet and getting information but it's not like you can get these drugs without going to a doc and getting a prescription.
I am on amytriptiline as well and have gained weight and have had NO desire to exercise or eat right. I wondered if it was the amytrip doing this to me and you've made me feel so much better so thank you. I used to be an exercise freak and only eat healthy foods but since being on the amytrip, I've been a couch potato with an ever-growing ass...LOL!
As to getting off the amytrip, I think you should go pretty slow. Weaning off a TCA can cause nausea and tremors etc. Laying off one half to one pill every few days or even a week at a time is probably slow enough but if you feel any weird effects, you should slow down even more. Listen to your body.
I don't know anything about St John's Wort except that it acts the same way in the brain as some AD's so a normal AD washout period should be observed I would think.
First things first though, get a new doctor if you can.
Good luck
tinac. > [from http://www.dr-bob.org/babble/tele/20010601/msgs/46.html]
>
> > Hi
> > I'm new to these pages and want some advice. I have what I think is called reactive depression. I've been through a few mega-traumas and upheavals in the past few years. I've coped, but if I get a bit extra on my plate, (nearly always workplace stress)
> > I get a visit from the "Black Dog".
> > Last year, the wading through treacle effect of the black dog got too much, so I went to see my GP. She prescribed Prozac...this gave me panic attacks and anxiety, so I changed it to Paxil after about three weeks. The Paxil was OK, but I could only tolerate half a tab, or else I got sick. It gave me headaches, but took away the depression. I found I became very foggy mentally after a while and my memory wasn't what it should have been. I came off the Paxil quickly (the withdrawal was horrendous!!!!) and managed medication free for a few months. Then stress at work and bang! the black dog came back. This time I got put on amytriptyline. This made me sleep......boy, did it make me sleep! This was lovely for a start, but I've become fed up of feeling sleepy all day, craving sugary foods and piling on the weight. Before the amytrip. I enjoyed physical activity, but my drive to do this (and diet!) has vanished.
> > I went to see the Dr. today, and it was the same idiot that diagnosed my daughter as having flu, when in fact it was a virus that killed her two days later. Needless to say, my confidence in him is not
> > exactly..err...great.
> > I'd done some research and said I wanted to come off amitrip. and try either Reboxetine or Venlafaxine. He said that he wouldn't prescribe those and all he would give me was Lofepramine.
> > I asked why and he said that the others were "too expensive" and "where did I find out about them anyway?" When i said the Internet,I got such a black look!
> > I wanted to know about coming off amytriptyline and withdrawal symptoms. He wouldn't (couldn't?) tell me and said to go straight onto Lofepramine.
> > I left, clutching my prescription, which I haven't had filled. I have decided to come off the amytrip. and try St. Johns Wort. I'm going to see a herbalist on Friday about this....needless to say, I'm worried whether the advice I get will be valid.
> > So, HELP! Can someone tell me -
> > How to come off amitrip and wot the side effects will be. I'm going to try half a pill every three days - is that OK?
> > Is Lofepramine any good and will it turn me into a half asleep Zombie like amitrip?
> > How long will I have to wait before starting the SJW?
> > Is the SJW any good for reactive depression?
> > Wot is good for this type of depression if SJW isn't, so I can go and see a (different!!!!) GP about it.
> >
> > Sorry about the rambling,
> >
> > Vixis.
Posted by SalArmy4me on July 10, 2001, at 13:23:30
In reply to Redirected: Advice wanted for newcomer, posted by Dr. Bob on July 10, 2001, at 9:45:34
Psychosomatics
Volume 61(5) September/October 1999 p 712 Dietary Supplements and Natural Products as Psychotherapeutic Agents
Fugh-Berman, Adriane MD; Cott, Jerry M. PhD:John’s Wort (Hypericum perforatum)
SJW is a common roadside plant (Figure 1, A) that has gained much popularity in the United States as an antidepressant (5, 6). Hypericum seems to be an effective antidepressant with an excellent safety profile, but more information is needed on its efficacy compared with SRIs. A MEDLINE search for “St. John’s wort” produced 1547 publications, and a search for “hypericum” produced 141 publications.
Many studies have been performed on this herb in Europe, primarily Germany. A recent meta-analysis evaluated 23 randomized trials (20 were double blind) of SJW in a total of 1757 outpatients with mild to moderate depression (7). Improvement in depressive symptoms (usually measured by the HAM-D or Clinical Global Impression scale) was observed in all groups. In 15 placebo-controlled trials, SJW was found to be significantly more effective than placebo. In eight treatment-controlled trials, clinical improvement in those receiving SJW did not differ significantly from those receiving tricyclic antidepressants.
Most trials were 4 to 8 weeks in duration. The trials in this meta-analysis were heterogenous and used various diagnostic criteria and dosages of herb. In 20 trials, single-herb preparations were tested; the remainder tested combination herb products. Thirteen trials compared a single hypericum preparation with placebo and provided data on treatment responders; of these, 55.1% of those receiving the herb improved, compared with 22.3% of those receiving placebo. No significant differences in treatment effect were found between single-herb preparations of SJW and standard antidepressants. Combination products (containing both hypericum and the sedative herb valerian) also were not significantly different from standard antidepressants. Side effects were reported less often with SJW; 19.8% of those on SJW reported symptoms, compared with 52.8% of those on tricyclic antidepressants.
Diagnostic criteria for depression also differ in Germany, and most of the SJW trials used ICD-9 diagnostic criteria (a few used ICD-10 or DSM-IV criteria). There are no clinical trials comparing SJW to SRIs. In Germany, SRIs became popular only recently; at the time that most SJW studies were performed in Germany, the usual treatment for depression was small doses of tricyclic antidepressants (eg, 75 mg/d imipramine). Whether SJW compares favorably with SRIs in terms of therapeutic benefit and side effects remains to be determined.
One 6-week trial from the United Kingdom (8) using DSM-IV criteria found that the proportion of patients responding to a daily dose of 75 mg of amitriptyline (34 of 78) was similar to those responding to 900 mg of hypericum (37 of 87), but by the end of the study, the total decrease in depression scores favored amitriptyline. Another 6-week trial in 209 more severely depressed patients examined the effects of larger doses of each medication (9). HAM-D scores in those receiving hypericum (1800 mg/d) decreased from 25.3 to 14.4, and in the imipramine (150 mg/d) group, scores decreased from 26.1 to 13.4. Although there was a small advantage for the tricyclic antidepressant over hypericum in both trials, fewer adverse effects were reported with SJW.
The National Institutes of Health National Center for Complementary and Alternative Medicine and National Institute of Mental Health recently contracted with Duke University to conduct a multicenter study comparing SJW with sertraline (Zoloft) and placebo in patients diagnosed with major depression.
Although SJW demonstrates MAO inhibition in vitro, this effect has not been demonstrated in vivo, nor have there been any reported cases of MAO inhibitor–associated hypertensive crises in humans using SJW (7). Although SJW inhibits serotonin, norepinephrine, and dopamine in vitro (10), the concentrations required to attain these effects are quite high and render the chances of attaining equivalent blood concentrations unlikely. The most potent effect of SJW seems to be on GABAA and GABAB receptors, with a median inhibitory concentration of 60 ng/ml for GABAA and 9 ng/ml for GABAB (11). Recent data suggest that a component of the extract called hyperforin may be more important to the therapeutic activity than hypericin (by which it is standardized) (12).
Adverse Effects and Interactions.
Side effects reported for SJW are generally mild. Gastrointestinal symptoms and fatigue have been reported (7). The most predictable effect seems to be photosensitization, especially in fair-skinned people. First noted in light-skinned cows that grazed in pastures in which SJW grew, photosensitization has been demonstrated in a controlled clinical trial involving hypericin and exposure to metered doses of UVA and UVB irradiation (13). Using LI 160, a standardized extract from Lichtwer Pharma (Berlin, Germany), these authors found a measurable increase in erythema in light-sensitive volunteers exposed to UVA irradiation after receiving 600 mg of SJW three times daily for 15 days. This effect has also been seen in humans taking high doses of synthetic hypericin (14). Photosensitization is generally mild and transient, disappearing within a few days of drug discontinuation. Although this effect is usually associated with higher than recommended doses of hypericum, it can occur at lower doses and generally appears on the package labeling as a precaution. No other adverse effects were observed in the high-dose studies.
Posted by SallyR on July 10, 2001, at 15:43:02
In reply to Redirected: Advice wanted for newcomer, posted by Dr. Bob on July 10, 2001, at 9:45:34
> I for one would recommend your going to a psychiatrist or psychopharmacologist instead of a GP. They are usually much more familiar with the various treatments and side effects.
Good luck.
Posted by Mitch on July 11, 2001, at 23:46:09
In reply to Redirected: Advice wanted for newcomer, posted by Dr. Bob on July 10, 2001, at 9:45:34
Hello,
It appears that your depressions are related to workplace stress and possibly excessive work. You mentioned that you had "reactive depressions".
Do you mean that these are reactive depressions to *overworking* generally or is there some other "reactive" stimulus outside of work that is triggering them??This raises two possiblities: 1) There are some "obsessiveness" traits that are wearing you out-in which case an SSRI AD like Prozac or Paxil might be a good idea (so you can "switch attention" and "put down" your workplace involvements when you aren't immediately involved in them.
2) You are *reacting* to negative evaluation from others or *perceived negative evaluation from other PEOPLE. In which case either an SSRI AD or an MAOI (ideally) could treat these symptoms.I can understand if you have a complex, difficult, detailed occupation that a sedating antidepressant can wreak havoc on your concentration and attention.
You also mentioned some sensitivity to Prozac-you had panic reactions to it. I am also very sensitive to antidepressants. There have been studies that have shown that 20mg/day of Prozac is effective for approx. 70 percent of people in a major depressive episode-however 50 percent of people will respond just as well with just 5mg/day. I think you may have been *overdosed* with Prozac. Also, Prozac accumulates in the body and for some people the blood levels can get very high with a relatively small daily dose.
The bottom line: You need an antidepressant. You need something that doesn't make you a zombie so you can function with a high-level job. Prozac would be good for attentiveness and for panic. My conclusion: Retry the Prozac at 5mg/day with a benzodiazepine such as clonazepam .5mg-1.0mg at bedtime to stop the panic.
Hope this helps some,
Mitch
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