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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by valene on March 10, 2006, at 9:40:17
Help!
I need advice on antidepressants. I am having increasingly bad depression where it is taking over my life. I take a benzo for anxiety, have for years.Prozac did not work for me before. I would like suggestions for a good antidepressant that is not too stimulating as I have the anxiety also. Thanks.
Posted by TylerJ on March 10, 2006, at 11:02:23
In reply to major depression med advice please, posted by valene on March 10, 2006, at 9:40:17
> Help!
> I need advice on antidepressants. I am having increasingly bad depression where it is taking over my life. I take a benzo for anxiety, have for years.
>
> Prozac did not work for me before. I would like suggestions for a good antidepressant that is not too stimulating as I have the anxiety also. Thanks.
>Well, I'll give you some ideas, but most important you need to see a PSYCHIATRIST not a gen doc..this is very important. As far as meds go, the ones I think are very good: SSRI's - Paxil, and zoloft. Heterocylic AD's - Tofranil. Tetracyclic ad's -I like Remeron a lot. Other misc ad's - Effexor and Effexor XR, Cymbalta, and Wellbutrin. Last but certainly not least, the MAOI's. I'm currenty on Parnate which has relieved all depressive and anxiety - for me it's the best I've taken in 25 yrs with this Illness. There is also a new Maoi called EMSAM which comes in a Patch so the medicine goes right into your blood not your gut...thus eliminating most diet restrictions and it also has a low side-effect profile. Please see your p-doc asap. These are ONLY my suggestions. Feel better.
Tyler
Posted by valene on March 10, 2006, at 11:38:47
In reply to Re: major depression med advice please » valene, posted by TylerJ on March 10, 2006, at 11:02:23
TY.......I do see a psychiatrist and will discuss these with him. He tends to prefer the SSRI's. I will explore the other types that you mentioned. I am particularly interested in the MAOI's but as you say in your post below I fear the side effects (restrictive diet). I guess it would be worth it to relieve this dark depression.
Val
>
> Well, I'll give you some ideas, but most important you need to see a PSYCHIATRIST not a gen doc..this is very important. As far as meds go, the ones I think are very good: SSRI's - Paxil, and zoloft. Heterocylic AD's - Tofranil. Tetracyclic ad's -I like Remeron a lot. Other misc ad's - Effexor and Effexor XR, Cymbalta, and Wellbutrin. Last but certainly not least, the MAOI's. I'm currenty on Parnate which has relieved all depressive and anxiety - for me it's the best I've taken in 25 yrs with this Illness. There is also a new Maoi called EMSAM which comes in a Patch so the medicine goes right into your blood not your gut...thus eliminating most diet restrictions and it also has a low side-effect profile. Please see your p-doc asap. These are ONLY my suggestions. Feel better.
>
> Tyler
Posted by TylerJ on March 10, 2006, at 11:54:41
In reply to Re: major depression med advice please, posted by valene on March 10, 2006, at 11:38:47
> TY.......I do see a psychiatrist and will discuss these with him. He tends to prefer the SSRI's. I will explore the other types that you mentioned. I am particularly interested in the MAOI's but as you say in your post below I fear the side effects (restrictive diet). I guess it would be worth it to relieve this dark depression.
>
> Val
> >
> > Well, I'll give you some ideas, but most important you need to see a PSYCHIATRIST not a gen doc..this is very important. As far as meds go, the ones I think are very good: SSRI's - Paxil, and zoloft. Heterocylic AD's - Tofranil. Tetracyclic ad's -I like Remeron a lot. Other misc ad's - Effexor and Effexor XR, Cymbalta, and Wellbutrin. Last but certainly not least, the MAOI's. I'm currenty on Parnate which has relieved all depressive and anxiety - for me it's the best I've taken in 25 yrs with this Illness. There is also a new Maoi called EMSAM which comes in a Patch so the medicine goes right into your blood not your gut...thus eliminating most diet restrictions and it also has a low side-effect profile. Please see your p-doc asap. These are ONLY my suggestions. Feel better.
> >
> > Tyler
>
>Val,
I'm glad that your interested in the maoi's because they are in my mind by far the best. I love Parnate! And the diet restrictions aren't that bad-I'll give you an updated list if/when you start an maoi. Really the only thing I miss is Cheddar cheese..small price to pay for how great i'm feeling. You can eat cottage cheese, cream cheese, american cheese, and most people here say Pizza is okay, if they only use mozzarella cheese on it..I haven't tried this yet. Remember, the doc and the drug manufacturer are going to give you a very conservative list of food and drugs to avoid to cover their as*es. Like no caffiene-heck you can drink caffiene as long as you do it in moderation. Good luck and let me know what you think and what your doc says.Ty
Posted by RobertDavid on March 10, 2006, at 15:43:44
In reply to major depression med advice please, posted by valene on March 10, 2006, at 9:40:17
If you don't respond well to other anti depressants like Prozac you might consider EMSAM which has just been approved. My doctor tells me the side effects should be less than most SRI's.
Posted by Emily Elizabeth on March 10, 2006, at 17:47:47
In reply to major depression med advice please, posted by valene on March 10, 2006, at 9:40:17
The key for you might be for a combo, rather than a single, magic bullet drug (although there are ups and downs w/ that approach as well). My problem is that everything would work for me a little, but not completely. So we kept adding. BTW, I have GAD and MMD. My current meds in the order that they were added:
Lexapro
Neurontin
Desipramine
Ambien
Dexedrine
LithiumThe Neurontin, Desipramine, and Lithium have helped the anxiety a lot. Also, Ambien has been really helpful w/ anxiety b/c inadequate sleep really increased my symptoms.
Pdoc and I think that the Lithium was the key in helping my MDD move to remission (fingers crossed, don't want to jinx it). In the next few months we'll look at weeding out some of the other meds.
If you and pdoc don't want to try Li, what about a TCA (e.g., desipramine)? They can help people who haven't found help w/ SSRI's.
Best,
EE
Posted by Phillipa on March 10, 2006, at 18:38:52
In reply to Re: major depression med advice please, posted by Emily Elizabeth on March 10, 2006, at 17:47:47
Luvox? it's sedating. Fondly, Phillipa
Posted by Racer on March 10, 2006, at 20:09:46
In reply to Re: major depression med advice please, posted by Emily Elizabeth on March 10, 2006, at 17:47:47
My pdoc just brought that up today, and I'm not terribly enthusiastic about anything new, unless I've checked out the Big Problems with people who actually take it. Yeah, I do listen to the doc, but I also want to know what people who have actually taken it have found.
My biggest buggaboos are constipation, weight gain, and amotivation/sedation. Have you found any of those to be a problem? Of course, so far in my life, I swear EVERYTHING causes constipation for me -- Metamucil causes constipation. And the amotivation/sedation is caused by nearly everything. Provigil made me need a nap...
But I do appreciate anything you can tell me about your experiences.
Posted by Emily Elizabeth on March 10, 2006, at 21:48:57
In reply to How are you liking Neurontin? » Emily Elizabeth, posted by Racer on March 10, 2006, at 20:09:46
I've taken it for quite a while now--around 3yrs, I think. When I first added it, I was primarily experiencing GAD w/ a little dysthymia. My anxiety wasn't sufficiently controlled by Paxil (plus a mini-dose of Wellbutrin to counteract sedation). So we added neurontin. I found it very helpful w/ rumination, but less so w/ the physical symptoms of anxiety. My pdoc said that most people had the opposite experience.
Side-effect wise, I don't think I have noticed anything. (Although I'm fairly tolerant of side effects). My impression is that Neurontin is known as a pretty low-side effect med. It also has relatively few drug interactions.
It is probably worth a shot. My sense is that you'll probably find a number of people who have NOT found it helpful, but fewer who quit b/c they had problems w/ it.
As for me, it is one of the drugs that pdoc and I are contemplating cutting down or cutting out when we start to cut down on my meds (although we both are a little too afraid to touch anything until I have been "well" for a longer period of time). Since it has been a while since I started it, I feel tempted to discontinue it to figure out if it is doing anything. Also, from my brief scan of the literature, my sense is that it has not been well supported for off label use, such as anxiety.
Sigh. Psychiatry is a little like some sort of voodoo at times, isn't it?
Best,
EE
Posted by Racer on March 10, 2006, at 23:39:47
In reply to Re: How are you liking Neurontin?, posted by Emily Elizabeth on March 10, 2006, at 21:48:57
> >
> Sigh. Psychiatry is a little like some sort of voodoo at times, isn't it?
>
> Best,
> EEGuess that explains the little doll my pdoc got out today...
(Thanks for your report. I have read that studies don't actually support it's use psychiatrically, but I'm trying to be willing to try things, if only to make my doctor a bit happier about my willingness to "cooperate" in my own treatment. (Grrr. Guys, I see my therapist, I work hard in there even when it's really unpleasant. I take my pills, even when I hate them. I don't mess around with the dosage I take. What exactly do you mean by cooperation?) She's getting easier for me to take, but I'm still not sure she's going to work out for me.
But for funnies, I swear my T is telling her everything I report, because first I told my T that I was having a lot of trouble with her telling me to "use your CBT skills" or "you have to do this," so that stopped. Then, I told my T that I found her humorless, after the last visit, today she was much more human and laughed. It's weird. Although maybe she's just very shy? Or she's starting to trust that I'm not going to sprout a set of horns?
Thanks again.
Posted by psychopharmacon on March 11, 2006, at 5:10:51
In reply to major depression med advice please, posted by valene on March 10, 2006, at 9:40:17
Perhaps it's the benzo that is making you increasingly depressed. Whenever I take Klonopin I get really depressed. Once I almost commited suicide, and it was probably because of the Klonopin I was taking at the time.
Posted by valene on March 11, 2006, at 8:30:15
In reply to Re: major depression med advice please, posted by psychopharmacon on March 11, 2006, at 5:10:51
I take xanax, 1.5mg and have for many years. I am actually down from 3mg. When I began taking xanax, it was highly promoted by Upjohn as having "antidepressant properties", a ploy to maximize their profit IMO. Though I did notice that Valium was much more depressive for me.
Val
> Perhaps it's the benzo that is making you increasingly depressed. Whenever I take Klonopin I get really depressed. Once I almost commited suicide, and it was probably because of the Klonopin I was taking at the time.
Posted by psychopharmacon on March 11, 2006, at 13:05:00
In reply to Re: major depression med advice please » psychopharmacon, posted by valene on March 11, 2006, at 8:30:15
Well, it seems like Xanax differs from the other benzos and could have an antidepressive effect.
"We observed a statistically significant increase in striatal dopamine concentrations..." Quoted from:
http://www.biopsychiatry.com/alprazolam.htmHave you tried Xanax at its lowest dosage? Some people say that 0.5 mg has a better effect than higher doses.
Posted by valene on March 11, 2006, at 16:01:59
In reply to Re: major depression med advice please, posted by psychopharmacon on March 11, 2006, at 13:05:00
Do I ever wish I was on .5mg. xanax! It's taken me a year to taper down to 1.5 from 3mg. Thanks for the link. I am convinced that some (not all) of the depression is due to withdrawal from xanax.
Val> Well, it seems like Xanax differs from the other benzos and could have an antidepressive effect.
>
> "We observed a statistically significant increase in striatal dopamine concentrations..." Quoted from:
> http://www.biopsychiatry.com/alprazolam.htm
>
> Have you tried Xanax at its lowest dosage? Some people say that 0.5 mg has a better effect than higher doses.
This is the end of the thread.
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