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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by kreedi on June 24, 2002, at 8:19:25
Month 7 of current (major) depressive episode. Beginning to feel "treatment refractory"; beginning to lose hope.
New psychiatrist, one I'm actually comfortable with, and who seems to know his stuff. (I live in India.) Just finished two weeks on Effexor XR -- week 1 on 37.5, week 2 on 75 mg. Will go up to 112.5 from tomorrow. No response so far. No bad side effect except major ejaculatory delay (which, I'm assuming, will only worsen as the dose goes up).
I seem to have responded to Prozac in the past, 20 mg. Have been on it for two significant periods of time in the past (in 1995 and 1997-98), and at least two more times for a few weeks. The delayed ejaculation was always there (but I could live with it).
The new pdoc suggested (i) going back on Prozac, (ii) Effexor XR, and (iii) Serzone. I chose the second option since I was worried that the Prozac might not be effective the third or fourth time round and because I'd read that Serzone wasn't that effective an AD.
Sertraline: complete anorgasmia, partial impotence. Paxil: anorgasmia. Celexa: was on it for nearly three months recently, going up from 10 mg to 40 mg -- no response. Remeron: excessive sedation (I'm very sensitive to antihistamines), which I think will not go even at doses like 45 mg. Also, alcohol would worsen the sedation problem. Wellbutrin: insomnia and weight loss, even on 150 mg. I'm very skinny, usually no more than 118 lbs, and I'm down to 108 lbs. 29 years old, male. (There's more to the meds history, but enough for now.)
In short, I don't know what to do, I feel I'm at the end of my metaphorical tether. Any response would be appreciated, but my specific questions are these: (i) If the Effexor doesn't work, and it doesn't feel like it's going to, should I simply go back to fluoxetine? Not worry about theoretical "poop-out" or that the nature of my depression has changed and so won't respond to Prozac? What are the studies on this? Or people's "anecdotal" experiences about multiple try-outs of the same drug? (ii) Augmenting -- effectiveness and safety of pindolol? Anything else that works well with venlafaxine or fluoxetine? (iii) Any other combinations: Remeron + Wellbutrin, for instance -- do the side effects cancel each other out? (iv) Worth trying Nardil (my pdoc seems reluctant)?
Thanks,
Kreedi (aka Jay)
Posted by Seamus2 on June 24, 2002, at 10:11:28
In reply to End of my tether? General med questions (long-ish), posted by kreedi on June 24, 2002, at 8:19:25
How would you characterise your depression? It might give us some ideas on a treatment strategy.
Posted by jay on June 25, 2002, at 2:32:23
In reply to End of my tether? General med questions (long-ish), posted by kreedi on June 24, 2002, at 8:19:25
Hey Jay..it's...well..Jay here too! lol..
Regarding being at 'the end of your tether', I honestly believe that is what so many of us feel, even after good trials with certain meds. But, that 'doesn't' lessen or disqualify your pain.
A message of 'hope' I seem to read alot of on this board, is that it often takes a bizzare, unconventional, sometimes off-label approach when it comes to our medications. Some folks are put off with 'polypharmacy', but that may be what it takes to hit back at your depression/anxiety. Depending on your condition, and it is usually trial and error, often an antidepressant (sometimes two from different classes..ie tricyclic/sri), combined with either/or a benzodiazepine, as well as both anticonvulsants and atypical antipsychotics (and there are quite a few of each..it will take a bit of time..plus there are many other meds in a class on their own..like Lithium..Buspar..) in a combo can hammer down many of your symptoms, so you can enjoy getting on with your life.
I know the above may sound scarry, but the *relief* that certain combo brings can make you wonder why you didn't seek help earlier. And yes, it does take a bit of time to let the medications set themselves into your body and system.
Also, just another important point...stopping a medication that was helpful for you is not a good idea. Relapse increases greatly when we stop a med that is helping. You may have to very well look at this as a long-term thing, and yes there *may* be some risk, but there is much more risk you living suicidal and unmedicated. Somebody on this board had a great saying they got from their doctor...that "..living unmedicated has side-effects, as well as living medicated". (Or something like that.)
Anyhow...just a perspective from a long-time, medicated, person with major depression and anxiety disorder for life.
I welcome your questions and any comments..and I think many on here have a lot to offer you, esp in support.
Best wishes...
Jay
Posted by kreedi on June 26, 2002, at 9:30:11
In reply to Re: End of my tether? General med questions (long-ish) » kreedi, posted by jay on June 25, 2002, at 2:32:23
Thanks for your responses. I'd characterize my depression as: dysthymic pretty much all my life, with superimposed major (unipolar) depression. The depressive episodes seemed to be acute (episodes at the ages of 10, 15, 21, 24) but now the depression seems to have become chronic. I've never been suicidal though, however bad it's been sometimes.
I guess one problem I have with staying on ADs is the sexual side-effects; I find them virtually intolerable (once I'm feeling better). But I have to accept, I suppose, the trade-off.
Feeling relatively good, actually, in the last couple of days, sudden (almost overnight) change. Up to Effexor XR, 112.5 a day. Still thinking of switching back to Prozac, though, perhaps augmented with pindolol, because of possibly fewer sexual side-effects. Does pindolol actually do that -- augment the efficacy and speed, as well as reduce the sexual side-effects, of SSRIs and venlafaxine?
Seamus -- I live in Bombay.
Kreedi (Jay)
This is the end of the thread.
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