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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by patc on March 1, 2003, at 16:28:17
Has anybody tried Gepirone during the trials?
Other than Nardil and Klonopin is there anything that helps w/ hard core Atypical Depression?
Thx.
Pat
Posted by jrbecker on March 2, 2003, at 10:40:26
In reply to Is Gepirone the magic bullet for Atypical Dep.?, posted by patc on March 1, 2003, at 16:28:17
I was in a gepirone trial but I received the placebo. I've heard fairly good things about Gepirone from the docs involved. In terms of comparing to the SSRIs based on mood effect alone, some believe it might be almost as equal in efficacy, and some have gone as far to say that it will be even better. But the real utility of the drug is that fact that it helps reduce the core atypical symptoms of eating, sleeping, and reduced sexual desire[somethin the SSRIs surely ain't helping with]. I always remain skeptical about new drugs myself. Every drug gets more hype than it should at first. Don't ever hold your breath on something that's not approved yet. If it turns out to be a wonderdrug, then great, but I've learned never to hold a candle for it in the meantime. Maybe the bigger question is whether gepirone will come close to Nardil as a treatment? For mood and anhedonia alone, I highly doubted.
And I guess that's your real question...what are the best treatments for anhedonic depression vs. just treating the atypical symptoms of hypersomnia, overeating, etc?
I don't think there's anything that comes close to the MAOIs but I think opioid therapy (e.g., buprenorphine) might have some promise. The TCAs might even rank a little higher than the SSRIs in terms of mood treatment for atypical depressives, but the real question is whether any of us can handle the side effects. In terms of the newer drugs, Effexor is probably the best new single drug treatment out there, but once again, it comes with a lot of side effects as well. And finally, if I had to choose an SSRI I favored for atypical, it would be celexa (better than lexapro in my opinion), which is the best pairing of tolerability with mood effects of its drug class. Augmentors like Klonopin (for anxious-types), hormonal options (e.g., Test., estrogen), as well as others such as NADH, selegiline, strattera, moclobemide, and even Buspar (I've found this one useless though); are all ones to experiment with.
But back to looking on the horizon...
Duloxetine is probably the best new drug to look out for in the near future (if you had any success with Effexor), which is probably available somewhere in the next 3-6 months. Further off, the selegiline patch seems to be making a lot of people cross their fingers (including myself). And sure, gepirone, might be something fairly useful as well.
Hope this helps,
JRB
> Has anybody tried Gepirone during the trials?
>
> Other than Nardil and Klonopin is there anything that helps w/ hard core Atypical Depression?
>
> Thx.
>
> Pat
Posted by Jack Smith on March 5, 2003, at 18:19:30
In reply to Re: Is Gepirone the magic bullet for Atypical Dep.? » patc, posted by jrbecker on March 2, 2003, at 10:40:26
> Duloxetine is probably the best new drug to look out for in the near future (if you had any success with Effexor),
JRBECKER,
Was curious about what drug you are on now? You said previously that you had a "good run" with effexor. Did it "poop out?" I am currently about to make a decision between effexor and Parnate/Nardil for my own atypical depression. Would you recommend a trail of effexor first? I have taken Celexa which worked great until a poopout and the only other drugs I have given an adequate trial to are Paxil (worked ok but sedated the hell out of me) and WB (OK augmentor of Celexa but didn't get me back to a remission.)
Any advice for a fellow atypical? (Also have GAD which can be pretty prominent.)
JACK
Posted by jrbecker on March 6, 2003, at 19:29:56
In reply to Re: Is Gepirone the magic bullet for Atypical Dep.? » jrbecker, posted by Jack Smith on March 5, 2003, at 18:19:30
> JRBECKER,
>
> Was curious about what drug you are on now?Currently on Celexa 20mg (my indiv. experience rates it higher than Lex), with augmentation of DHEA (or sometime Pregnenolone instead).
>You said previously that you had a "good run" with effexor.
Yes, while taking effexor, it was probably the most "productive" time of my life. Was running marathons, getting cum laude grades at an ivy league school, and being highly social.
>Did it "poop out?"
No, not at all. It's just that I had issues with the side effects that made me feel it might be right to try a straight SSRI again. The side effects for me included: excitability, increased BP, slight dysphoria, tiredness at times, and anorgasmia. Although I am an atypical depressive (associated with low cortisol output), I fit more into the model of a PTSD sufferer (low cortisol but high peripheral aderenaline). In terms of the Effexor, this means that it was a great help to my "mental" anxiety and depression, but was not a good match for my active "flight or flight" jumpiness of already-high sympathetic output.
At the time I decided to give it up, I was in a very stressful job (working 11 hour days) after having recently moved to NYC. I did not feel I needed the extra stimulation brought on by the NARI component of the drug. A move to celexa proved to be a little more my speed.
In genreal, I believe Effexor to probably be the best monotherapy agent among the newer antidepressants. However, it's definitely not right for everyone.
>I am currently about to make a decision between effexor and Parnate/Nardil for my own atypical depression. Would you recommend a trail of effexor first?It seems rational to try the Effexor first. In terms of motivation, it will give you a lot more energy, although there might be sometimes where you'll feel tired. In terms of treating anhedonia [which is my own biggest issue], Effexor ranks probably higher than any SSRI by itself, but is still outmatched by MAOIs. Bottom line, if I was in your place, I'd allow myself a 6-8 week trial of Effexor before I went the way of the MAOIs. Just my view on it.
>I have taken Celexa which worked great until a poopout and the only other drugs I have given an adequate trial to are Paxil (worked ok but sedated the hell out of me) and WB (OK augmentor of Celexa but didn't get me back to a remission.)
> Any advice for a fellow atypical? (Also have GAD which can be pretty prominent.)
As for the GAD component, Effexor is great. It made me highly social and productive. So don't confuse my "physical anxiety" with GAD, these are quite different. Worrying was not as much an issue as was the excitability factor for me.Of course, another consideration might be the celexa again, but added to Strattera -- something of a similar effect of what you'll find from effexor.
Hope this was useful feedback. Good luck.
JRB
Posted by Jack Smith on March 6, 2003, at 19:56:02
In reply to Re: Effexor...? » Jack Smith, posted by jrbecker on March 6, 2003, at 19:29:56
> As for the GAD component, Effexor is great. It made me highly social and productive. So don't confuse my "physical anxiety" with GAD, these are quite different.
Your answers are extremely helpful. We seem quite similar--I too am an ivy league graduate and my symptoms manifested themselves during a very successful academic time in law school.
How are "physical anxiety" and GAD different? My anxiety manifests itself in clearly "physical" ways--lumps in throat and tightness/burning in chest (it's not like heartburn and I have been tested for acid reflux and for more serious heart problems). This is what led my Doc to diagnose me with GAD. Am I missing something??
Posted by KrissyP on March 7, 2003, at 22:33:20
In reply to Just one more Q re GAD » jrbecker, posted by Jack Smith on March 6, 2003, at 19:56:02
Hi,
You write, "As for the GAD component, Effexor is great. It made me highly social and productive. So don't confuse my "physical anxiety" with GAD, these are quite different"R U SURE?
GAD is ANXIETY- I know when I got anxiety-it affected me physically BAD-Do you mean "emotional anxiety"??
Just wondering,
Kristen
-------------------------------------------------
> > As for the GAD component, Effexor is great. It made me highly social and productive. So don't confuse my "physical anxiety" with GAD, these are quite different.
>
> Your answers are extremely helpful. We seem quite similar--I too am an ivy league graduate and my symptoms manifested themselves during a very successful academic time in law school.
>
> How are "physical anxiety" and GAD different? My anxiety manifests itself in clearly "physical" ways--lumps in throat and tightness/burning in chest (it's not like heartburn and I have been tested for acid reflux and for more serious heart problems). This is what led my Doc to diagnose me with GAD. Am I missing something??
Posted by jrbecker on March 8, 2003, at 0:29:23
In reply to Re: Just one more Q re GAD » Jack Smith, posted by KrissyP on March 7, 2003, at 22:33:20
You're right in saying that GAD can also manifest itself through physical features as well, including those you mentioned, such as palpitations, sweating, etc. However, many individuals with GAD do not have elaborate physical symptoms as the core feature of the disorder(think of it more in terms of a negative component of ADD or a strong feeling of constant rumination and doubt). In other words, the root of GAD is cognitive/mental in nature, causing physical stress by result. Somewhat different from this is the heightened sympathetic output seen in PTSD-sufferers [and the like, in my case], in which, regardless of any sense of current worry or anxiety, there is always a strong NE release going on, leading to physical excitability/agitation/exhaustion.
This is the difference I alluded to before in terms of what your response to Effexor might be in comparison to my own.JRB
Posted by KrissyP on March 8, 2003, at 0:30:32
In reply to Re: Just one more Q re GAD, posted by jrbecker on March 8, 2003, at 0:29:23
This is the end of the thread.
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