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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by qbsbrown on December 28, 2006, at 14:09:23
I think that my PDOC feels about 2. I was curious about others experiences and sucesses of switching classes.
Brian
Posted by Phillipa on December 28, 2006, at 17:40:38
In reply to How many SSRIS do U try before an SSNRI?????, posted by qbsbrown on December 28, 2006, at 14:09:23
Tried them all and the SSNRI's nothing but on cymbalta no more pain in my back. Love Phillipa
Posted by yxibow on December 28, 2006, at 18:15:40
In reply to How many SSRIS do U try before an SSNRI?????, posted by qbsbrown on December 28, 2006, at 14:09:23
> I think that my PDOC feels about 2. I was curious about others experiences and sucesses of switching classes.
>
> BrianIt depends how long you can tolerate depression and how immediate the pain of depression and frankly, the potential of suicide, apathy, and all the other things that accompany it.
I think that if one is going through SSRIs they should try at least an activating and a more sedating one -- not necessarily Prozac, although it is the most activating, but it takes 35 days to flush out of the system, and a sedating one, either Paxil or Luvox.
Then you might try Effexor, which is sort of an SSRI and sort of an SSNRI and if you can't stand it because of its harshness, then Cymbalta I would imagine.
But that's just a guess -- there are many paths and combinations.
-- tidings
Posted by qbsbrown on December 28, 2006, at 23:06:45
In reply to Re: How many SSRIS do U try before an SSNRI????? » qbsbrown, posted by yxibow on December 28, 2006, at 18:15:40
So the sedating ones help w/ ocd features and anxiety, but worsen depression, as the stimulating ones worsen OCD and racing thoughts, but improve the depression.
Which ones are the middle ground?
Brian
Posted by yxibow on December 29, 2006, at 5:02:27
In reply to But YXIBOW, posted by qbsbrown on December 28, 2006, at 23:06:45
> So the sedating ones help w/ ocd features and anxiety, but worsen depression, as the stimulating ones worsen OCD and racing thoughts, but improve the depression.
>
> Which ones are the middle ground?
>
> BrianI wouldn't say that the sedating ones worsen depression per se -- that's a personal biochemical issue... they're just easier on the system with tapering I think and generally help people who don't respond well to stimulating ones because they have high anxiety disorders mixed with depression.
Do they do a complete job against depression? No, probably not... I mean I was on Luvox at 400 to 450 and eventually was switched to Cymbalta because it helped my depression better but is not doing much for obsessive thoughts, but I must say Luvox is really good for OCD at as high a dose as one can stand -- it has a wide dosing range. The only "gold standard" better is Anafranil, with some side effects to bear.
The middle ground -- that's hard to say... perhaps Lexapro ? Its really an individual thing unfortunately, I can't offer more than that, because people respond differently depending on what mix of anxiety and what type of depression.
-- Jay
Posted by qbsbrown on December 29, 2006, at 9:24:33
In reply to Re: But YXIBOW » qbsbrown, posted by yxibow on December 29, 2006, at 5:02:27
Funny you mention, either anafranil or cymbalta was my next option.
Why did u not try both at same time, u can mix a tricyclic right?
Brian
Posted by jimmygold70 on December 29, 2006, at 10:26:08
In reply to How many SSRIS do U try before an SSNRI?????, posted by qbsbrown on December 28, 2006, at 14:09:23
As a rule of the thumb 2, but now you have more SSRIs so it depends on your symptoms. Are you anxious? do you sleep too much or too little?
> I think that my PDOC feels about 2. I was curious about others experiences and sucesses of switching classes.
>
> Brian
Posted by qbsbrown on December 29, 2006, at 10:26:59
In reply to Re: How many SSRIS do U try before an SSNRI????? » qbsbrown, posted by jimmygold70 on December 29, 2006, at 10:26:08
Anxious, oh yes. Sleep too little.
Posted by myblusky on December 29, 2006, at 12:20:01
In reply to Re: How many SSRIS do U try before an SSNRI?????, posted by qbsbrown on December 29, 2006, at 10:26:59
I went from Paxil, to Lexapro, to Wellbutrin to Prozac before I found the one that worked - Prozac. By the time I got to the Prozac I was ready to give up. I actually went off the Prozac after a week because of side effects, but realized I needed medication so I went back on it. I spoke to people who encouraged me to stay on it and wait out the side effects. I also adjusted the dose to every other day after speaking with my therapist. My entire family is very sensitive to medications so we require very low doses. The dosage change has made a big difference and I feel so much better now. My depression has receeded greatly.
I spoke to someone who told me it took his friend two years to find the correct combination of medications. That was not very encouraging though. This trial and error system is very difficult for people with depression.
Posted by Phillipa on December 29, 2006, at 18:47:46
In reply to Re: How many SSRIS do U try before an SSNRI?????, posted by myblusky on December 29, 2006, at 12:20:01
Yes and especially when you're older and have tried all of the SSRI's and SSNRI's but now your body has changed so they might work differently. So how do you decide? And I though luvox in Europe was approved for depression not just OCD? Love Phillipa ps plus don't they say all the SSRI's are approved for OCD now?
Posted by elanor roosevelt on December 29, 2006, at 20:29:53
In reply to Re: How many SSRIS do U try before an SSNRI????? » myblusky, posted by Phillipa on December 29, 2006, at 18:47:46
on Luvox I had no nails or cuticles on feet or hands unravaged
i couldn't get out of the house with the checking for my keys and this and that and this and that
Posted by Phillipa on December 29, 2006, at 21:10:13
In reply to Re: How many SSRIS do U try before an SSNRI?????, posted by elanor roosevelt on December 29, 2006, at 20:29:53
Luvox did that to you? I thought it was for OCD. And the most sedating SSRI. So are you saying it made you anxious? Love Phillipa ps and you can take parnate? I don't understand ?
Posted by med_empowered on December 29, 2006, at 22:50:33
In reply to How many SSRIS do U try before an SSNRI?????, posted by qbsbrown on December 28, 2006, at 14:09:23
there isn't a formula. If a patient might respond to an antidepressant (and lots of people don't) your doc should select one to match your symptoms. SSRIs are more tolerable for *some* people, but they have side effects of their own so...you may want to start out with an SNRI. Or TCA. I dont think people usually start out with MAOIs, but I imagine that could be an option in certain cases.
Posted by jimmygold70 on December 30, 2006, at 4:29:46
In reply to Re: How many SSRIS do U try before an SSNRI????? » qbsbrown, posted by jimmygold70 on December 29, 2006, at 10:26:08
Then three SSRIs are relevant - paroxetine, escitalopram, citalopram. Especially paroxetine. Zoloft and especially Prozac may be too stimulating for you. So I would go with paroxetine and then (es)citalopram or switch to Remeron or Effexor. All are viable options.
J
> As a rule of the thumb 2, but now you have more SSRIs so it depends on your symptoms. Are you anxious? do you sleep too much or too little?
>
> > I think that my PDOC feels about 2. I was curious about others experiences and sucesses of switching classes.
> >
> > Brian
>
>
Posted by naughtypuppy on December 30, 2006, at 10:16:14
In reply to Re: How many SSRIS do U try before an SSNRI?????, posted by med_empowered on December 29, 2006, at 22:50:33
> there isn't a formula. If a patient might respond to an antidepressant (and lots of people don't) your doc should select one to match your symptoms. SSRIs are more tolerable for *some* people, but they have side effects of their own so...you may want to start out with an SNRI. Or TCA. I dont think people usually start out with MAOIs, but I imagine that could be an option in certain cases.
>
I think a lot of people are first prescribed whatever the doctor has the most samples of. What a system .Out of a 10 minute appointment half of that time is spent rifeling through a cupbord for samples. I once saw a pharmacy rep bringing in samples into a doctors office. There were so many he had to use a push cart. How can they afford to give away such massive quantities yet charge us a kings ransom for the same thing?>
Posted by elanor roosevelt on December 30, 2006, at 11:01:00
In reply to Re: How many SSRIS do U try before an SSNRI????? » elanor roosevelt, posted by Phillipa on December 29, 2006, at 21:10:13
> Luvox did that to you? I thought it was for OCD. And the most sedating SSRI. So are you saying it made you anxious? Love Phillipa ps and you can take parnate? I don't understand ?
the parnate came after 7 or 8 years of ssri's and mood stablizers and such
the parnate was a nightmare
other nightmares:
serzone
neurotine
topomax
depokate
prozac
cymbaltaokay for a while meds
paxil
wellbutringood but eventual (and sudden)meltdown
celexa
lexaproi think i left out about 20
anyone know a good pdoc in nyc?
This is the end of the thread.
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