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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 Mandy on March 12, 2006, at 18:10:27
I know everyone is different. I have had depression (maybe bipolar) since 1991. I have been many meds but latest combo of Wellbutrin SR 150mg (I can't take XL because of gastric bypass),
lexapro 10 mg, Lamictal 300mg, Rozerem at night and klonopin 2-3mg. My psych wants me off klonopin but thinks other meds do not need readjusted or changed. But I feel so much more depressed and lack of energy. I did recently have a major job change which may be causing some of this,but I am afraid I will lose this job if I don't get depression fixed. Any ideas?
Posted by Racer on March 12, 2006, at 18:46:32
In reply to Opinions on best antidepressant, posted by Mandy on March 12, 2006, at 18:10:27
Well, as you mention, everyone's different, but I found both Lexapro and Lamictal very, very -- well, not quite sedating, but more paralysing. On Lexapro, it didn't touch my depression, but at 10mg, I nearly couldn't talk, because it would take too much energy and wouldn't be worth it. Lamictal wasn't quite that bad, but it was still pretty amotivating. It may be that you're getting some of that response, too, from one or both of those drugs.
Here's a question, which may help you find a better cocktail (why do I think the question should be "gin or vodka?") -- think back, did any of those drugs work for you when you first took them? Was there that "WOW! THIS is what remission feels like!" moment? Or was this, "Well, this is a bit better, but" and then add another drug? If it was the former, heading back to where you were then makes some sense. But if it's the latter, well -- time to try another approach.
What meds have you been on, and what did they do for/to you? Any horrible experiences -- really bad, like me getting so paralysed by Lexapro, or some people get terrible hypotension on some TCAs -- or really great responses that just faded over time? Any of those might help give some clues about a good choice for you.
Also, what sorts of symptoms are you targetting? And what sorts of adverse effects are deal killers for you? Again, that helps narrow it down...
Based only on what you've said, I'd say maybe swapping the Lexapro for Zoloft or Prozac, just because they might be less sedating, or even Paxil might be worth a try -- but only if the Lexapro helped your depression enough that it would make sense to stay in the same class. Otherwise, maybe look into a TCA like nortriptyline or desipramine; maybe Cymbalta or Effexor, although Effexor XR is better, but it sounds as though that would be a no-go for you; Remeron and Wellbutrin might be a worthwhile possibility.
What makes it so hard, of course, is the part about having to keep a job while trying all this. I'm so sorry you've got all that going on at once.
Good luck.
Posted by Phillipa on March 12, 2006, at 19:16:03
In reply to Re: Opinions on best antidepressant » Mandy, posted by Racer on March 12, 2006, at 18:46:32
Racer good answer you covered most of them. Fondly, Phillipa
Posted by TylerJ on March 13, 2006, at 7:27:25
In reply to Re: Opinions on best antidepressant » Racer, posted by Phillipa on March 12, 2006, at 19:16:03
> Racer good answer you covered most of them. Fondly, Phillipa
Yeah, but he did forget or just not mention my favorites..The MAOI's :)
During the last 25 yrs. I've tried nearly everything including many combos, and even ECT treatments..YUK! I forget what I was going to say..just kidding :) For me the absolute best anitdepressants have been Parnate and Nardil, especially Parnate. Before starting Parnate I was severely depressed, anxious, had both OCD and Social anxiety disorder. Now after 5 wks on Parnate and 5 mgs of ativan daily I have 0 depression, 0 anxiety, 0 OCD, and 0 social anxiety. Parnate has been my miracle drug, but that's just me..good luck with whatever you try.Tyler
Posted by Racer on March 13, 2006, at 13:31:20
In reply to Re: Opinions on best antidepressant, posted by TylerJ on March 13, 2006, at 7:27:25
> >
>
> Yeah, but he did forget or just not mention my favorites..The MAOI's :)Yeah, I know. I skip them on questions like this for two reasons: I don't know much about them, have never taken them, so I don't feel qualified to comment; but mostly because I do tend to think of them as medications to try after trying a few of the easier drugs.
That's coming from someone who eats Asian food a couple of times a week. Lots of soy sauce, and since I'm cooking for two, the soy-sauce-substitutes would have to pass his approval as well as my own. (And my husband is as picky an eater as I am...) Also, I'm a semi-recovering anorexic, so anything that limits the foods I can eat turns into a problem for me, and I figure I'm not unique in that -- there are probably lots of people who really would have trouble with dietary restrictions.
But I am glad they're working for you, and have actually adjusted my thinking enough to consider Parnate as one of the next options when and if I need it. (After trying Emsam, probably...)
Posted by yxibow on March 13, 2006, at 16:42:58
In reply to Opinions on best antidepressant, posted by Mandy on March 12, 2006, at 18:10:27
> I know everyone is different. I have had depression (maybe bipolar) since 1991. I have been many meds but latest combo of Wellbutrin SR 150mg (I can't take XL because of gastric bypass),
> lexapro 10 mg, Lamictal 300mg, Rozerem at night and klonopin 2-3mg. My psych wants me off klonopin but thinks other meds do not need readjusted or changed. But I feel so much more depressed and lack of energy. I did recently have a major job change which may be causing some of this,but I am afraid I will lose this job if I don't get depression fixed. Any ideas?
Its very simple to say, but the best antidepressant is the one that works for you and your condition(s). I can say that Cymbalta works for my secondary depression but doesnt quite cover my obsessive garbage thinking but this probably means nothing to you.They did a huge study, which has been mentioned, called Star*D for treatment refractory depression, which can be seen at
http://www.edc.gsph.pitt.edu/stard/ (the first link in the paragraphs on the page leads you to the numerous links)
There was a link on the net by some psychiatrist that said that if he was on a desert island, he would pick amitriptyline because all of its side effects had efficatious properties. But again, that's just academic banter.
And then we get to what is the definition of fully treated, managed, efficatious, completely efficatious, which has been a hot button here and was also part of the study.
So -- this time I'll pick unicorns, its like beating a dead unicorn.. because what works best, works for you, considering there are probably a dozen at least if not moreantidepressants if you go all the way back to what is still on the shelves.
Tidings- Jay
Posted by Racer on March 13, 2006, at 20:15:58
In reply to Re: Opinions on best antidepressant » Mandy, posted by yxibow on March 13, 2006, at 16:42:58
> >
> So -- this time I'll pick unicorns, its like beating a dead unicorn..lol -- The Problem is that this creates such a strong and stunning visual image. It's too funny.
Posted by yxibow on March 14, 2006, at 2:51:53
In reply to I don't think you really understand the problem, posted by Racer on March 13, 2006, at 20:15:58
> > >
> > So -- this time I'll pick unicorns, its like beating a dead unicorn..
>
> lol -- The Problem is that this creates such a strong and stunning visual image. It's too funny.
>
>It was an inside joke because I used a phrase incorrectly in a previous post. I was trying to interject the proper phrase. I swear I'm a pacifist, I'm a vegetarian. :)
But finding the right medication is no joke -- I think the problem is not what is the right antidepressant, but the pearls of wisdom gained from people on their experiences of side effects -- and even those can only be taken in the scientific sense of a "case report."
I'm not sure, other than to reduce medication load and possibly decrease depressive symptoms from clonazepam -- they are real and can be bad for some people, why the doctor wants to remove it but thats my only guess.
The bariatric surgery I am not familiar with the restrictions on it, but I assume XL would accumulate to a toxic level, theoretically? Although even 2x 150 is still a clinical dose. That I can't comment much on. Up the dose of lexapro? That's really for your doctor to decide, I can't play proxy.
Best wishes
-- Jay
This is the end of the thread.
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