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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by love bites again on September 18, 2004, at 3:56:26
I've been on Paxil for over 4 years now and have been emotionally flat for most of that time. I've only come to realize lately that it's an effect of the Paxil. I was starting to think I had a brain tumor or something and it never occured to me that it was the Paxil. Anyway, I'll need an antidepressant for life as I have the type of chemical imbalance that will always be out of whack when not on a stabilizer. My question is which antidepressant deadens your emotions the least? Is Lexapro better for not killing off all your joy and feelings?
Posted by theo on September 18, 2004, at 7:49:02
In reply to Emotionally Flat on Paxil - is Lexapro Better?????, posted by love bites again on September 18, 2004, at 3:56:26
I went to Lexapro from Paxil and for me it was a huge mistake. Lexapro is good for depression, but INCREASED my social and general anxiety. If you are taking Paxil only for depression, it may be worth the switch but Lexapro does not do much at all for anxiety. I gave Lexapro 16 weeks which I think is a fair evaluation and that the anxiety I was experiencing was not an initial start up side effect.
The only reason I tried Lexapro was because it was "new" and "hyped up" which was a big mistake.
Posted by King Vultan on September 18, 2004, at 10:26:51
In reply to Emotionally Flat on Paxil - is Lexapro Better?????, posted by love bites again on September 18, 2004, at 3:56:26
> I've been on Paxil for over 4 years now and have been emotionally flat for most of that time. I've only come to realize lately that it's an effect of the Paxil. I was starting to think I had a brain tumor or something and it never occured to me that it was the Paxil. Anyway, I'll need an antidepressant for life as I have the type of chemical imbalance that will always be out of whack when not on a stabilizer. My question is which antidepressant deadens your emotions the least? Is Lexapro better for not killing off all your joy and feelings?
My opinion is that you will likely find all of the SSRIs to be like this. To avoid the problem, you need to go with a drug that also works strongly on norepinephrine, and if at also works on dopamine, that wouldn't hurt either. I did not find Effexor to be much better than an SSRI for preventing emotional blunting, but I never took it above 150 mg/day, either (it becomes more noradrenergic at higher dosages). Cymbalta might be a better choice, as it is supposedly less skewed towards serotonin than Effexor is, but I have not really had the time to read what people are saying about it. Other drugs I've tried that did work in regard to what you are looking for have been the tricyclics and MAOIs.Todd
Posted by Racer on September 18, 2004, at 11:45:45
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?????, posted by King Vultan on September 18, 2004, at 10:26:51
I experienced the same sort of emotional flattening on Paxil, but didn't on Effexor -- or, for that matter, on some of the other SSRIs. Lexapro, though, was a different story. I wasn't just emotionally flat -- I was just FLAT. Period. No interest, no energy, no nothing -- it was like being dead, just a zombie. That was, as far as I can recall, at 5mg (half a small tablet).
For relief from the emotional flattening, your choices would probably be from the more activating SSRIs or the SSNRIs like Effexor or Cymbalta, or -- if the activation isn't a problem for you -- maybe Wellbutrin. Then, of course, as King Vultan pointed out, there are the older drugs, like TCAs and MAOIs. Those are good drugs -- so far, all the ADs are about as effective from a statistical standpoint, it's the side effect profiles that are different.
My advice to you, for what it's worth, is to check on the side effects listed for the various ADs out there, make a list of the side effects you, personally, would find most and least tolerable, and then talk to your doctor about the options available within those boundaries. For example, if your blood pressure is on the higher side, some of the TCAs might be a good choice for you, or if you want a more sedating drug, Remeron might be a good choice.
Unfortunately, psychopharmacology is, by its very nature, an exercise in trial and error. If the Paxil has worked for your depression, then there's a good chance that another SSRI will also work for you, and some of the others are much less physically and emotionally sedating.
Best luck.
Posted by scottlaen on September 18, 2004, at 13:26:07
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?, posted by Racer on September 18, 2004, at 11:45:45
I was on Paxil (20mg) for 7 years, and can definitly say that Lexapro does not dull your emotions nearly as much. Regarding the issue of lack of motivation, I think there may be something to that.
However, I was emotionally flat on Paxil for so long and after getting off that crap (with the help of lexapro), I can feel my emotions clearly. It did increase my agitation and anxiety which sucks.
Of course this is most likely different for everyone, and also depends on the dosage you are taking of the drug. Personally, I am taking 10mg Lexapro daily.
I've heard nightmare stories about Effexor, and have had a bad experience with Zoloft. I tried Wellbutrin, but that stuff didn't do anything for me at all. I haven't heard of Cymbalta- anyone care to share their experiences w/that one?
Posted by Philidor on September 18, 2004, at 15:41:45
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?, posted by scottlaen on September 18, 2004, at 13:26:07
Yeah, I think one of the other posters was right about all the SSRI's tend to do that because they work mainly by increasing serotonin.
And that's great when you're seriously depressed. But the downside can be more subtle. It's like, the sound quality is much better, but the dynamic range is much less. The louds aren't as loud, and the softs not as soft as in a live performance.
Like lately I noticed that I was taking a greater interest in sex than I have for awhile.(Thinking, dreaming, glancing, etc.)
Then I realized that 2 weeks ago I'd cut my Lexapro dose from 20mg to 10.
That can be the problem. You often don't notice what you're missing. But your friends and intimates may notice the difference, and they may start to lose interest, too. In YOU.
Posted by love bites again on September 18, 2004, at 18:32:49
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?, posted by scottlaen on September 18, 2004, at 13:26:07
You guys are GREAT! Thanks for the feedback - it's a big help.
I feel so stupid. I went on paxil because I'd had weird physical reactions to several antidepressants (like lumps forming on my legs). I never gave it a second though because it did keep my boughts of deep depression away. I went from an energetic, happy go lucky, outgoing, 110 lb 30 year old, to gaining 40lbs the first year on Paxil. I got lazy, tired, dopey and unmotivated. I had to read things 3,4 even 5 times to try and get them to "stick" in my brain and then I'd give up on it. My passion for painting disappeared completely along with any of my usual "happy" feelings toward anything. I stopped going to my kid's sporting events because I didn't want to be around anyone and didn't want to have to shower, do my hair and makeup. I used to take great pride in mysef. The list goes on and on. I was convinced that this was *all* caused by a thyroid condition that wasn't showing up on any of the tests and I even toyed with the idea that maybe I've got a brain tumor. How could I be so blind? I never ever ever considered the Paxil - never. It didn't even occur to me - and I'm a fairly intelligent woman. By accident the other day I looked up Paxil, to see if maybe I wan't taking enough and that's perhaps why my interest in things is gone. I found this site and others and began to cry - you've described *me* (or the lack of me). I've waisted 5 years - I've been so blind. Why didn't I figure it out? I researched every other possibility to death and missed the obvious. I'm definitely going to wean myself off the Paxil, I just know I can't go without an antidepressant of some kind. Thank you so much for being here to help and for giving me some much overdue advice.
hugs
Cheryl
Posted by Racer on September 18, 2004, at 18:54:27
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?, posted by love bites again on September 18, 2004, at 18:32:49
Don't beat yourself up over this one -- just be glad the internet is here so that you can find this information now. When I took nortiptyline ages ago, I truly believed that I was getting horribly fat because I was unable to control my eating because I was such a rotten person! NOT exactly therapeutic. When I took Paxil, the weight gain hadn't shown up yet, so -- again -- I thought I was just a rotten person, unable to control my impulses. (At least the sexual side effects were known -- otherwise I'd have been as despondent without the depression as with it.) And I had no idea how much the Paxil was draining me of anything like normal energy until after I stopped it. (I stopped it when my friend's son committed suicide and I found I couldn't grieve for him -- and for her. I wanted a "normal" reaction, and couldn't see how to have it with the drug.)
So, cut yourself some slack, be glad you do have the information now, and best luck to you.
Posted by Philidor on September 18, 2004, at 20:03:01
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?, posted by love bites again on September 18, 2004, at 18:32:49
You know, something just occurred to me. I've been on this anti-depressant merry-go-round for many years now.
And when I started out, with the tricyclics, the were like antibiotics. Once the depression cleared up, they would take you off the drug, or reduce you to a fractional "maintenance dose" which you'd finally just forget about taking.
But TODAY, it seems, once you start on a AD, they want you to stay on it at the same dose FOREVER (keeps that awful depression from coming back, you see.)
Now is that MEDICINE telling us to do that or $$$$?
Posted by love bites again on September 18, 2004, at 20:06:30
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better? » love bites again, posted by Racer on September 18, 2004, at 18:54:27
Thanks Racer. I am increadibly relieved to finally know that it's the Paxil!! I have an answer and it's not *just me* - I have a chance to recover *me*, my personality. I don't have to stay this way - what a relief. Thank God for consumer reviews, because otherwise we wouldn't know the real effects of these drugs - I bet my doctor doesn't even know.
You mentioned Cymbalta - I haven't heard of this one before - have you heard much about it? I should do a search on the net and see if that one may be a possibility.
Again ~ thanks
Cheryl
Posted by love bites again on September 18, 2004, at 20:21:40
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?, posted by Philidor on September 18, 2004, at 20:03:01
That's a good question Philidor. I bet that there are some people who don't need to worry about relapses, and who could safely stop taking antidepressants after they've been in the clear for a while. When I first started taking them, it wasn't known whether my depression would be chronic (biological) or a one time passing thing, so after I began to feel better, my doctor slowly took me off meds. I was good for about a year but then it hit again (out of the blue) and was stronger than ever and harder to treat, so I was diagnosed as being a sufferer of chemical imbalance and the meds are needed on a permanent bases. I don't think I could ever chance having that dark a depression again - it was horrific. The thought of it even scares me.
So in answer to your question, I think it depends on the person and the type of depression they suffer from.
Cheryl
Posted by zeugma on September 18, 2004, at 20:25:35
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?, posted by Philidor on September 18, 2004, at 20:03:01
> You know, something just occurred to me. I've been on this anti-depressant merry-go-round for many years now.
>
> And when I started out, with the tricyclics, the were like antibiotics. Once the depression cleared up, they would take you off the drug, or reduce you to a fractional "maintenance dose" which you'd finally just forget about taking.
>
> But TODAY, it seems, once you start on a AD, they want you to stay on it at the same dose FOREVER (keeps that awful depression from coming back, you see.)
>
> Now is that MEDICINE telling us to do that or $$$$?
>
One thing to keep in mind is that tricyclics have little in the way of discontinuation syndrome. SSRI discontinuation is often harsh enough, and pdocs naive enough about this fact (I would use another term, but I think you get my drift) to lead to indefinite use of these drugs: because, you see, SSRI's aren't addicting in any sense of the term, so worsening of condition must be the depression coming back.These factors do tie in nicely to monetary interests. But that is only a coincidence.
-z
Posted by Racer on September 18, 2004, at 20:41:30
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?, posted by love bites again on September 18, 2004, at 20:06:30
Cymbalta is brand spanking new. Just approved on 4 August of this year by the FDA. It's a selective serotonin and norepinephrine reuptake inhibitor, so it does a bit more than the SSRIs do, which also means that it's got different side effects. There's another drug with similar effects -- Effexor -- but Cymbalta is supposed to have a more balanced effect on the two neurotransmitters than Effexor, which is a bit skewed towards serotonin at lower doses, with the norepinephrine side kicking in as the dosage goes up. (I can't remember, but it may also affect dopamine at high enough levels.)
There are so many of these drugs out there now that it's often possible to find one that works without causing a lot of grief. It's still trial and error, but having some idea of which side effects are most distressing for you is always helpful -- for example, my blood pressure runs low to begin with, so anything that causes hypotension is probably a bad idea, and I can't handle the weight gain, so that's usually what usually causes me to discontinue a drug. On the other hand, cyproheptidine works well enough for me to counteract the sexual side effects, so that's less of a deal-killer. Knowing those things about yourself will help you work with your doctor to choose a better option for yourself.
As for whether or not one needs to take it forever, that's a hotly debated issue. The consensus I've come across lately says that ADs should be continued for two years for an initial episode of depression, after which they're tapered off. If the depression returns, then five years is recommended, again tapering off. Now, those time frames are starting from the time one reaches full remission, not from when the drug is started.
I, too, have a history of recurrent depressive episodes, and I can tell you that I have gone off anti-depressants after each episode. There's generally a period of a few years before the next episode starts, and for me it's worth being med-free during those times. I do that knowing that it's likely the depression will return, but again -- it's worth it to me. (Then again, I've never been on anything that would be tolerable and effective indefinitely. Either the side effects get to be too much for me, or the med stops working, or both.)
I hope that helps, and best luck.
Posted by love bites again on September 18, 2004, at 21:43:08
In reply to Cymbalta » love bites again, posted by Racer on September 18, 2004, at 20:41:30
You're a big help Racer! I have to say, that Cymbalta sounds promising. I wonder if it's in Canada yet - we always seem to be a year or so behind the U.S. with drugs getting approved.
I've also found the sexual side effects to be brutal, but less disturbing than the constant flat emotional haze, although my husband would probably reverse their order of importance LOL. On the meds I'd be quite content to be celibate indefinitely.
Do you know if the people who've come off Paxil have had their personalities and emotions totally restored? Or are we going to find out tnext that this stuff does permanent damage?
Cheryl
Posted by Racer on September 19, 2004, at 15:01:16
In reply to Re: Cymbalta, posted by love bites again on September 18, 2004, at 21:43:08
I can only tell you my own experience with it: the Paxil didn't so much change my personality as just sedate me totally, physically and emotionally. Coming off of it, which I did cold turkey because I didn't know any better, was not much of a problem and I felt like me again -- only with more energy, able to achieve orgasm, and with a wider emotional range. No permanent damage.
The weight I gained on it didn't come off so easily, though, and the depression did come back, although it didn't get *really* bad for a number of years, and the next episode was triggered by a whole slew of stressors all hitting at once: my building was sold to a slumlord who didn't fix a broken heater, leaving me without heat all winter; I was injured at work; I lost my job at about the same time I was injured; my father was diagnosed with cancer; my father then put huge demands on me during the time I was in physical therapy for my injury; I had to deal with worker's comp; I was trying to undergo retraining; my father then died; and I decided to move to another county where I knew very few people. Those are most of the stressors, but there were a few others, too -- I think you can see that that episode was earned honestly, right? And, frankly, it took one last straw once I moved to bring on the real crash, up until then, I was able to function -- albeit, not at optimal levels.
I hope that helps.
Posted by Philidor on September 19, 2004, at 16:32:56
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better? » Philidor, posted by zeugma on September 18, 2004, at 20:25:35
Yes, zeug, you're right. I'm sure it is a coincidence. I get so cynical sometimes.
But correct me if I'm wrong. I seem to recall that the SSRI's were originally introduced as wonderful IMPROVEMENTS over the old fashioned trycylics---you know, faster, safer, more effective, fewer and milder side effects?
Now, 20 some years later, have ANY of these claims been validated?
On the contrary, wasn't there a study a few years ago, a big one that caused quite a stir, that indicated that the SSRIs were NO more effective than the TCAs for depression and were in fact SUPERIOR to them for SEVERE depression?
Side effects? Well the TCA's did have those anticholinergic effects (dry mouth, drowsiness, difficulty taking a wee). More nuisances than big problems, as I remember.
But thanks to the SSRIs we can say goodbye to all that, and hello to SEXUAL dysfunction(impotence, loss of libido, anorgasmia) and that's just the most common SE (around 40% of patients, I think it is.)
And the SSRI "discontinuation effects"? Guess they forgot to tell us about those. With the TCAs, the only discontinuation effects were losing the side effects. The worst that could happen, if you foolishly ignored your doctor and stopped them suddenly, was that your depression would bounce back, and you'd be right back where you were(dummy!).
But there were none of these nightmarish withdrawal syndromes that we're seeing with the SSRIs. Websites and forums devoted to them are all over the net. Often they read like scenes from Edgar Allen Poe or Steven King.
And what you've gotta love, it's that many of these very people who've been burned by these dangerous drugs just CAN'T WAIT to try the latest one!
What can you say? Guess Barnum was right. EOM
Posted by love bites again on September 19, 2004, at 21:09:51
In reply to Re: Cymbalta » love bites again, posted by Racer on September 19, 2004, at 15:01:16
Good God Racer, talk about getting hit from every angle possible! If problems would only come one at a time instead of in tidal waves, eh? Wow, I'm glad you got through it all and are here to share your wise advice, though I know it couldn't have been easy. I too lost my Dad (suddenly) during this time and I wish I could have figured out all this crap about the Paxil before losing him so I could have done more with him instead of sitting here like a bump on a log.
I can't wait to feel like myself again. To get my passions back for my painting, to feel alive and awake and to feel excitement. I want to *want to be* sociable again, to feel like respecting my appearance again, to have the energy to rid myself of the weight that came on from paxil. I want to enjoy doing things with my kids again and to feel butterflies in my tummy when I'm happy - I miss that. I used to enjoy talking and visiting and I've been darned close to being a shut in for 4 years, avoiding people, not wanting to speak at all, not to ANYONE. I do have a renewed hope that maybe I'm not lost forever! I just have to find that alternative AD that will keep my depression at bay and still let me feel alive and figure a way to lose these pounds which seem resistant to efforts to get rid of them, although I haven't really had the energy to put forth much of a consistant effort. Has anything worked for you?
Cheryl
Posted by Dr. Bob on September 20, 2004, at 7:22:43
In reply to Re: - is Lexapro Better?, posted by Philidor on September 19, 2004, at 16:32:56
> many of these very people who've been burned by these dangerous drugs just CAN'T WAIT to try the latest one!
>
> What can you say? Guess Barnum was right.Please don't post anything that could lead others to put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by Racer on September 20, 2004, at 15:22:19
In reply to Re: Cymbalta, posted by love bites again on September 19, 2004, at 21:09:51
I've taken other ADs since the Paxil, with varying results. This isn't a very good time to ask if anything else has helped, because I've just come out of a year long struggle with a county health system that really hasn't helped at all. Being uninsured ain't at all pretty.
There are so many new medications out there now, though, that it should be possible to get the benefits without so many side effects for most people. I'm trying Cymbalta right now, which hasn't convinced me of anything yet. If this doesn't work, I suspect the next choice is Wellbutrin. I'm trying to suspend judgement until the Cymbalta has a chance, though.
Best luck to you.
Posted by Philidor on September 20, 2004, at 18:32:19
In reply to Re: please be civil » Philidor, posted by Dr. Bob on September 20, 2004, at 7:22:43
> > many of these very people who've been burned by these dangerous drugs just CAN'T WAIT to try the latest one!
> >
> > What can you say? Guess Barnum was right.
>
> Please don't post anything that could lead others to(feel)put down.
>
May I merely point out, doc, that a strict enforcement of this rule would not merely limit free speech here. It would ABOLISH it.I'll have more to say on this point at admnistration. See you there!
Phil
Posted by love bites again on September 20, 2004, at 19:23:08
In reply to Re: - is Lexapro Better?, posted by Philidor on September 19, 2004, at 16:32:56
> And what you've gotta love, it's that many of these very people who've been burned by these dangerous drugs just CAN'T WAIT to try the latest one!
>
> What can you say? Guess Barnum was right. EOM
Is your frustration directed at the drug companies or at the patients who hold out hope that they may come up with a med that efficiently addresses their depression without the awful side effects?
Cheryl
Posted by Philidor on September 20, 2004, at 20:12:40
In reply to Re: - is Lexapro Better?, posted by love bites again on September 20, 2004, at 19:23:08
> > And what you've gotta love, it's that many of these very people who've been burned by these dangerous drugs just CAN'T WAIT to try the latest one!
> >
> > What can you say? Guess Barnum was right. EOM
>
> Is your frustration directed at the drug companies or at the patients who hold out hope that they may come up with a med that efficiently addresses their depression without the awful side effects?
> Cheryl
>
I would say that my ANGER is directed at the drug hucksters who take advantage of the misery of these patients and my FRUSTRATION is that so many of these poor dupes keep believing their lies, just as I myself did for many years.("Fool me once, shame on you...fool me TWICE...")
Phil
Posted by karaS on September 20, 2004, at 23:30:12
In reply to Re: - is Lexapro Better?, posted by Philidor on September 20, 2004, at 20:12:40
> > > And what you've gotta love, it's that many of these very people who've been burned by these dangerous drugs just CAN'T WAIT to try the latest one!
> > >
> > > What can you say? Guess Barnum was right. EOM
> >
> > Is your frustration directed at the drug companies or at the patients who hold out hope that they may come up with a med that efficiently addresses their depression without the awful side effects?
> > Cheryl
> >
> I would say that my ANGER is directed at the drug hucksters who take advantage of the misery of these patients and my FRUSTRATION is that so many of these poor dupes keep believing their lies, just as I myself did for many years.
>
> ("Fool me once, shame on you...fool me TWICE...")
> Phil
And what about all of the people who have been greatly helped by some of these medications? I, unfortunately, have not been one of them yet but I do know several people whose lives have turned around completely because they've had so much success with a particular medication or medications. You really can't argue with success.
Posted by Dr. Bob on September 21, 2004, at 8:02:56
In reply to Re: - is Lexapro Better?, posted by Philidor on September 20, 2004, at 20:12:40
> these poor dupes
Please don't post anything that could lead others to feel put down. I've asked you to be civil before, so now I'm going to block you from posting for a week.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
> I'll have more to say on this point at admnistration. See you there!
I didn't see anything there just now, but please feel free to email me.
Thanks,
Bob
This is the end of the thread.
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