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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Linda from Sweden on January 29, 2007, at 19:13:50
Hi!
Anxiety and depression is my problem. After many years, SSRI stop working after weeks now, maybe this is the same for all drugs, but there most be something longer lasting!? I take Klonopin, so anxiety is under control. But I know after many years that depression will come back after stopping SSRI, actually I feel very good for a month or so after stopping. After reading posts, I am thinking about 2 meds; Wellbutrin or Lamictal (as an AD).
Can someone give some facts about WB, what transmitters, any long time users WB alone or combo?
And the same for Lamictal?
I would continue with my Klonopin, but it would be nice to add just one more med. that work in the long run, not a complicated combo with many meds.
I have some sleep problems, maybe I should go in the opposite direction, amitryp monotherapy in evening? Isn’t that like the mother of all TCA’s, with nortryp as a metabolite? Any comments on amitryp? For me it looks like you get everything in one pill! (and all se....)
Or other suggestions?
Love Linda
Posted by Meri-Tuuli on January 30, 2007, at 9:53:48
In reply to No more SSRI, what now?, posted by Linda from Sweden on January 29, 2007, at 19:13:50
Hi!
I'd try St John's Wort a herbal remedy. It acts abi t like a SSRI. Don't be fooled that just because its a herbal remedy it isn't 'strong' or anything - its very nice. I'd give it a go personally.
You can read more about it at:
Its sort of a p-babble for St John's wort. I can't remember what the name is in Swedish (I live in Finland). Tensor (a Swedish speaking Finn) will know through - I think it has something to do with Midsummer......Johanniskraut, Johannesört?? Anyway St John's Wort in English.
Kind regards
Hag-vind
Posted by tensor on January 30, 2007, at 10:27:39
In reply to No more SSRI, what now?, posted by Linda from Sweden on January 29, 2007, at 19:13:50
Hi Linda,
I'm also suffering from both depression and anxiety and have recently been trying both Wellbutrin/Zyban and Lamictal. If you live in Sweden, Wellbutrin is not available, however, Zyban is. Zyban is the same substance but indicated only as an aid to quit smoking, it can be prescribed off-label (if you find the right pdoc) but no insurances will cover it and it is pretty expensive.
I have never been an SSRI responder but you seem to be one (or was), adding Wellbutrin to an SSRI is a common practice and often works well, e.g. Zoloft+Zyban. Lamictal made me tired but works very well for some, it is suggested that it's probably more effective for bipolar depression. If you haven't tried any TCAs (or SNRIs) yet, don't even consider Lamictal yet.>For me it looks like you get everything in one pill! (and all se....)
I wouldn't start with the strongest TCA, you don't want the s/e it gives you. Have you tried any SNRI like Efexor, Ixel, Cymbalta or Remeron? You could try to add Remeron to your current SSRI, as of matter of fact it could be the most logical step. Or switch to one of the above.
Could you list your current and previous meds?
As Meri-Tuuli pointed out, there is Johannesört. En naturmedicin som fungerar lite som SSRI-preparat och ungefär samma biverkningar inkl. sexuella.
/Mattias
Posted by Linda from Sweden on January 31, 2007, at 19:23:35
In reply to Re: No more SSRI, what now? » Linda from Sweden, posted by tensor on January 30, 2007, at 10:27:39
Hi Mattias!
After clomipramine, I have mostly stayed with SSRI, Prozac for many years, then Celexa good for many years, changed to Lexapro and because of increased anxiety from Lex I “finally” started Klonopin regulary. Celexa and Lexapro are not the same! Going back to Celexa was no good. Lex poop-out and lately I stayed with Prozac on and off, best AD effect of the SSRI’s for me, but strange and difficult to get very stable and the right dosage, because of the long half life and metabolites. It’s unpredictable, sometimes you get the feeling 5 mg has more AD effect than 20 mg! In the early days I was on 60 mg, but I realize know I was a zombie then! But I always feel like a million dollars after stopping, like now, but it never last for more than a month or so. My medication now is Klonopin 1 mg x 2 day and Prozac in my system.
I have tried St John's Wort, just little effect, had to stop because I am much outside in winter skiing, and on a sunny day with fresh snow, I almost get blind! :-)
I am sensitive to meds that makes me feel “strange”, clean SSRI makes me feel most normal, but poop-out so fast. So maybe I need to target NE in some way that don’t make me feel wired, but I still think 5ht must be in the lead.
I am slim, but I don’t like the weight gain issue with Remeron. I have not tried Efexor or Cymbalta, don’t feel there is very much positive said about these on babble, I don’t know, maybe I should give it a try? I don’t have like major depression, but after a while without an AD I feel sad, more anxious, little OCD, no physical or mental energy, can’t sleep or work….
Maybe clomipramine again? Or is it just like a dirty SSRI….like Paxil, what’s the difference?
Love Linda
Posted by tensor on February 1, 2007, at 9:19:23
In reply to Re: No more SSRI, what now? » tensor, posted by Linda from Sweden on January 31, 2007, at 19:23:35
Hi Linda,
Why did you quit clomipramine? It is an effective AD, but have rather strong anticholinergic and antihistamine properties which will cause dry mouth, constipation, impaired cognitive functions etc. and weight gain (H1 block). Also, the alpha1 block gives orthostatic hypotension, which can be bothersome. These effects are not so prominent with Paxil.
I think an SNRI could be worth a try because of a generally better s/e profile. They (and SSRI) do not possess the cardiotoxicity that the TCAs do. You could combine Prozac with a small dosage of Remeron, e.g. 15mg, that dose doesn't cause any significant weight gain for me, but everybody is different. Also, what is written here about meds is not carved in stone. Effexor can be a real pain, but works very well some, the same goes for Cymbalta and any other med. I think Remeron is one of the "smartest" drugs around. Another SSRI that you didn't mention is Zoloft which may have a weak dopaminergic effect and is also approved for OCD. Well worth a try.You can babble-mail me if you wish.
/Mattias
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