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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 58. Go back in thread:
Posted by Neal on March 28, 2009, at 0:55:43
In reply to Re: most POTENT AD for resistant anxiety+depression???, posted by Phillipa on March 28, 2009, at 0:43:09
doxepin (brand name Sinequan) worked for me, but is a TCA. But where you're at - I wouldn't worry about that too much right now.
Can be sedating at first, but maybe that's a good thing?
Posted by michael45 on March 28, 2009, at 1:27:26
In reply to Re: most POTENT AD for resistant anxiety+depression???, posted by Incubusfan on March 27, 2009, at 22:23:21
okay thanks ill try that..i heard nardil read nardil worked pretty good too..
hmmm one more question... is nardil usually hard to get, because ive heard that doctors usually look down on it and say its too dangerous?
> I would try Nardil if I were you. It's pretty much the gold standard for anxiety and depression. Work your way up on the dose slowly though, so you can adjust to it.
>
> Good luck.
>
> > okay well i have this horrible tension feeling combined with this killer depression and im about to admit myself into a hospital if i cant figure this out soon...
> >
> > ive tried:
> > -lexapro- worked:] then pooped out:[
> > -prozac- numbed me out, felt horrible
> > -zoloft- felt even worse
> > -cymbalta- no change, felt horrible
> > -wellbutrin- made me super agitated
> > -lamictal- made me feel super agitated and horrible
> > -klonopin- helped for a week for anxiety (then tolerance started to kick in) but made depression worse
> > -ativan- made me tired, but didnt do s*** for anxiety? wow haha
> > -trazodone- barley did anything for sleep and nothing for anything else
> >
> >
> >
> > ...im going to the shrink this week and dont know what to try next...im getting pretty desperate and will even try shock therapy (ECT) if that will help hah.. seriously!
> >
> > what are good antidepressants that work well for both anxiety + depression..forget about all that ssri/snri bull**** or anything like those..
> >
> > i need some top of the line potent stuff...MAOIs? remeron? maybe even the crude TCAs? idk whats works good for you guys???
> >
> >
> > pleaee helpp out!!
> >
>
>
Posted by Alexanderfromdenmark on March 28, 2009, at 5:09:12
In reply to most POTENT AD for resistant anxiety+depression???, posted by michael45 on March 27, 2009, at 21:31:39
About Nardil
is it still as effective as it used to be? I heard pzifer changed the fillers in the drug ingredients and many people found it less effective. Is that still going on?
Posted by mav27 on March 28, 2009, at 8:41:51
In reply to Re: most POTENT AD for resistant anxiety+depression???, posted by Alexanderfromdenmark on March 28, 2009, at 5:09:12
sure is. otherwise no one would be taking it.
Posted by Zana on March 28, 2009, at 14:38:35
In reply to most POTENT AD for resistant anxiety+depression???, posted by michael45 on March 27, 2009, at 21:31:39
Don't forget all the atypical antipsycotics. I've tried Abilify, Seroquel. There is also Respirdal.
There are also mood stabilizers that can help with anxiety like Gabapentin and Topamax.
Do you have a good pdoc who will work through this with you? Even if you go for ECT, you will still need meds that keep you in remission. Without meds or "maintenance" ECT the remission rate is 100% according to docs I've spoken to at McLeans in MA.
Posted by Relapse on March 28, 2009, at 16:16:24
In reply to Re: most POTENT AD for resistant anxiety+depression???, posted by Zana on March 28, 2009, at 14:38:35
Echo that from Zana. My problem is level 10 anxiety that pushes me into depression. Have delt with it for years. I seem to respond to Zoloft somewhat. This time my doc augmented it with lithium, which he said would help the Zoloft work. It also helps with mood stabilization. The 3rd drug I now take is Seroquel an atypical antipsycotic. This is the first time I have had to take a cocktail of drugs to get my anxiety/depression under control, but let me tell you, it was out of control. Good luck we are all pulling for you.
Posted by desolationrower on March 28, 2009, at 22:40:40
In reply to most POTENT AD for resistant anxiety+depression???, posted by michael45 on March 27, 2009, at 21:31:39
well, it might be that the tension is a dsyphoric mania, and it sounds like you have lots of insomnia? i think you should clarify if you have bipolar symptoms. if so, something like valproate or quietiapine or aripiprazole might be helpful; if not, either a tca or maoi. probably a tca only if anxiety is less bad than depression, adn more of the panic type. tca is probably less ideal. MAOIs are pretty good for bipolar depression, although mixed state you're going to need a mood stabilizer.
have you discussed with your pdoc bipolar? if you haven't even discussed it, you should probably find a new one (although, it might be good to get stabilized first). also take a look at http://www.psycheducation.org/index.html
i tend to the think most potent antidepressant is polypharmacy.
-d/r
Posted by garnet71 on March 29, 2009, at 1:08:50
In reply to most POTENT AD for resistant anxiety+depression???, posted by michael45 on March 27, 2009, at 21:31:39
Effexor wasn't on your list.
Posted by desolationrower on March 29, 2009, at 4:29:50
In reply to Re: most POTENT AD for resistant anxiety+depression??? » michael45, posted by garnet71 on March 29, 2009, at 1:08:50
> Effexor wasn't on your list.
wouldn't be on my list of most potent ads, either.
-d/r
Posted by emme on March 29, 2009, at 6:15:12
In reply to most POTENT AD for resistant anxiety+depression???, posted by michael45 on March 27, 2009, at 21:31:39
Hi. It looks like you have only tried monotherapy with these drugs. Have you tried anything in combination? And have you titrated slowly from a low enough dose that you didn't end up on a higher dose than you needed?
What about a benzo (maybe xanax or xanax XR) to help calm down a stimulating AD? What about prozac + zyprexa? How long were you on Lamictal - long enough for the startup effects to wear off? Maybe a dash of seroquel with it to calm things down while your body adjusts? I don't know how Effexor + Remeron would be for anxiety, but it might help you depression. My point is, you haven't begun to scratch the surface of options. Is your pdoc a good psychopharmacologist?
Good luck,
emme
Posted by michael45 on March 29, 2009, at 6:50:03
In reply to Re: most POTENT AD for resistant anxiety+depression??? » michael45, posted by emme on March 29, 2009, at 6:15:12
well first i had lorazepam
then lorazepam + lexapro
then lorazepam + cymbalta
then lorazepam + zoloft + wellbutrin
then lorzeapam + zoloft
then klonopin + lamicital (i was on 50mg of lamictal and 2-3mg of klonopin for at least a month and didnt do anything, just the klonopin helped calm me down)
then klonopin
then buspar
then buspar + prozac + trazdone
then prozac + trazodone
then trazodonenow im on nothing for the last 2 weeks and im going nuts...im tired of trying these first line medicines...idk i cant find a doctor who will take me seriously i guess or something:[ idk i'll just pray that me and my doctor can work something out next week
Posted by michael45 on March 29, 2009, at 6:55:33
In reply to Re: most POTENT AD for resistant anxiety+depression???, posted by Incubusfan on March 27, 2009, at 22:23:21
okay thanks ill try that
..i heard nardil read nardil worked pretty good too..
hmmm one more question... is nardil usually hard to get, because ive heard that doctors usually look down on it and say its too dangerous?...i just have this gut feeling that my pdoc will start telling me about how dangerous MAOIs are avoid the topic of those medicines and all that...ughhhhh f***
Posted by michael45 on March 29, 2009, at 6:58:59
In reply to Re: most POTENT AD for resistant anxiety+depression???, posted by Neal on March 28, 2009, at 0:55:43
did the Sinequan help you out with social anxiety or things about that matter??
..i mean i dont have social anxiety to the extend of it being diagnoised as social phobia..i just want something that wont make me feel like a hermit crab like prozac did...
Posted by michael45 on March 29, 2009, at 7:28:24
In reply to Re: most POTENT AD for resistant anxiety+depression???, posted by desolationrower on March 28, 2009, at 22:40:40
no i dont really have bipolar symptoms..i feel the same all day longg
...im in a constant state of agitated major depression with some anxiety..its like feeling super depressed but at the same time feeling an intense feeling of inner restlessness...sucks A**my pdoc thought it was some type of bipolar after the ssri's didnt work so he tried lamictal..but i didnt respond good to it, so im sure i dont any type of bipolar disorder...idk what to do
but when you mean polypharmacy do you just mean mixing 2 ADs at once?
Posted by emme on March 29, 2009, at 7:28:52
In reply to Re: most POTENT AD for resistant anxiety+depression??? » emme, posted by michael45 on March 29, 2009, at 6:50:03
Hmm.....still lots of options and lots of meds you haven't tried. As SLS points out, the potential permutations are huge.
The other posters have a good point about the Nardil.
For Lamictal, 50 mg may have still been too low a dose and a month may not have been long enough. Maybe it's just not the drug for you, but something like seroquel might do a better job of calming you.
I found Wellbutrin + serzone + a benzo to be very good, but I don't think serzone is often prescribed these days.
I of course am biased in favor of what is working for my anxiety and depression: Lamictal + Ability (+ xanax prn + focalin sort of prn).
Good luck and don't give up.
emme
Posted by michael45 on March 29, 2009, at 7:54:44
In reply to Re: most POTENT AD for resistant anxiety+depression??? » michael45, posted by emme on March 29, 2009, at 7:28:52
yeah i wanna try nardil but pdocs never want to prescribe it nowadays from what i hears...
but thanks for everything:]
Posted by garnet71 on March 29, 2009, at 8:23:00
In reply to Re: most POTENT AD for resistant anxiety+depression??? » desolationrower, posted by michael45 on March 29, 2009, at 7:28:24
> no i dont really have bipolar symptoms..i feel the same all day longg
> ...im in a constant state of agitated major depression with some anxiety..its like feeling super depressed but at the same time feeling an intense feeling of inner restlessness...sucks A**
__________________________________________Did you read that link that was posted by d/r? It describes what you just said. Here's the part about agitation, anxiety, inner restlessness as a symptom of bp:
http://www.psycheducation.org/depression/Anxiety.htm
I had questioned whether or not I have bpII, so I came across this and it sounds just like what you wrote. Anxiety in the mix def. complicates things.
Posted by garnet71 on March 29, 2009, at 8:39:32
In reply to Re: most POTENT AD for resistant anxiety+depression??? » michael45, posted by garnet71 on March 29, 2009, at 8:23:00
Michael,
You might want to read this page too:
http://www.psycheducation.org/depression/02_diagnosis.html#soft
There's a lot of good info on that site--it looks at bp from many different angles, unlike some of the other stuff I've read in the past. Take a few minutes and read..
Effexor seems different than the other xxRIs. It might have the same effect as the others you tried, then again, it might not. It worked for me when the SSRIs I originally made me feel depressed and horrible.
Posted by bleauberry on March 29, 2009, at 9:17:01
In reply to most POTENT AD for resistant anxiety+depression???, posted by michael45 on March 27, 2009, at 21:31:39
Parnate.
Nardil.
Clomipramine.Look no further.
If you have not tried those three, you have no business even thinking of ECT.
I am an ECT survivor. It didn't work. It cost $22,000 for 12 sessions. Did you know the relapse rate is 85% within 4 weeks? Did you know most people who do well on ECT require polypharmacy of drugs to stay well? It's not as if you are going to get ECT and say goodbye to the drugs.
The above three ADs. From anecdotal observations, I believe nothing has the power that Parnate does. Nardil would be tried if Parnate was not acceptable for some reason after trying it.
For some interesting reading on this topic and others I know will be of interest to you, go to PsychoTropical.com and read the stuff Dr. Gillman has to say. In particular, read his page on Parnate where he also comments on Nardil.
At forums where people rate their meds, a winning combo for anxiety+depression is Parnate+Klonopin.
Posted by polarbear206 on March 29, 2009, at 9:20:06
In reply to Re: most POTENT AD for resistant anxiety+depression??? » emme, posted by michael45 on March 29, 2009, at 6:50:03
Considering the multiple AD med failures, and your symptoms, this may be a red flag for an underlying bipolar disorder. There is a broad spectrum with this illness. I would take D's advice and research psycheducation.org. This is an excellent site and Dr. Phelps can give you some insight if you e-mail him. Good luck.
Posted by polarbear206 on March 29, 2009, at 9:22:46
In reply to Re: most POTENT AD for resistant anxiety+depression???, posted by garnet71 on March 29, 2009, at 8:39:32
> Michael,
>
> You might want to read this page too:
>
> http://www.psycheducation.org/depression/02_diagnosis.html#soft
>
> There's a lot of good info on that site--it looks at bp from many different angles, unlike some of the other stuff I've read in the past. Take a few minutes and read..
>
> Effexor seems different than the other xxRIs. It might have the same effect as the others you tried, then again, it might not. It worked for me when the SSRIs I originally made me feel depressed and horrible.
I am also an Effexor success story. Same thing as above mentioned. I also take Lamictal with it.
Posted by NewQuestions on March 30, 2009, at 9:27:27
In reply to Re: most POTENT AD for resistant anxiety+depression???, posted by bleauberry on March 29, 2009, at 9:17:01
You should also consider the possibility that your body can't tolerate drugs anymore.
Posted by michael45 on March 30, 2009, at 11:09:07
In reply to Re: most POTENT AD for resistant anxiety+depressio, posted by NewQuestions on March 30, 2009, at 9:27:27
so your saying im fu****? lol
Posted by Meltingpot on March 30, 2009, at 13:18:18
In reply to most POTENT AD for resistant anxiety+depression???, posted by michael45 on March 27, 2009, at 21:31:39
Michael,
You sound like me. Have you tried Zyprexa?
Denise
Posted by NewQuestions on March 30, 2009, at 13:36:23
In reply to Re: most POTENT AD for resistant anxiety+depressio » NewQuestions, posted by michael45 on March 30, 2009, at 11:09:07
How long did they work before poop out?
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Dr. Bob is Robert Hsiung, MD,
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