![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by davidla on February 25, 2012, at 10:55:16
I know everyone responds differently - I am just looking for the med with the best chance of working even if the advantage is slight.
Looking to treat these symptoms in order of severity:
1. Depression
2. Social Anxiety
3. OCD
4. IrritabilitySSRI options in order?
1. Effexor XR (venlafaxine)
2. Cymbalta (Duloxetine)
3. Paxil (Paroxetine)Best augmentation?
1. Klonopin (for anxiety)
2. Anafranil (for OCD)
Posted by SLS on February 25, 2012, at 11:05:33
In reply to Best non-MAOI for these symptoms?, posted by davidla on February 25, 2012, at 10:55:16
> I know everyone responds differently - I am just looking for the med with the best chance of working even if the advantage is slight.
>
> Looking to treat these symptoms in order of severity:
> 1. Depression
> 2. Social Anxiety
> 3. OCD
> 4. Irritability
>
> SSRI options in order?
> 1. Effexor XR (venlafaxine)
> 2. Cymbalta (Duloxetine)
> 3. Paxil (Paroxetine)
>
> Best augmentation?
> 1. Klonopin (for anxiety)
> 2. Anafranil (for OCD)
I would try making Anafranil your core treatment around which to augment and treat residual symptoms. As far as choosing what drugs to use as augmenters, it depends on what symptoms remain to be treated.
- Scott
Posted by Phillipa on February 25, 2012, at 12:02:15
In reply to Re: Best non-MAOI for these symptoms? » davidla, posted by SLS on February 25, 2012, at 11:05:33
Paxil as I didn't gain weight on it at low doses, or again I mention luvox no weight gain either, and klonopin or another benzo. And yes I sound like a broken record. Phillipa
Posted by ed_uk2010 on February 25, 2012, at 12:38:07
In reply to Best non-MAOI for these symptoms?, posted by davidla on February 25, 2012, at 10:55:16
>I know everyone responds differently - I am just looking for the med with the best chance of working even if the advantage is slight.
> SSRI options in order?
> 1. Effexor XR (venlafaxine)
> 2. Cymbalta (Duloxetine)
> 3. Paxil (Paroxetine)I do not know what you've tried so far, but I would start out with sertraline (Zoloft), citalopram (Celexa) or if affordable escitalopram (Lexapro). Effexor, Cymbalta and Paxil tend to cause more adverse effects (and more severe withdrawal symptoms) - these are not generally first-line medications.
>Best augmentation?
> 1. Klonopin (for anxiety)
> 2. Anafranil (for OCD)Klonopin is effective for most types of anxiety, but is not reliable for OCD. For me, it causes more adverse effects than SSRIs. Memory loss, sedation, dependence and disinhibition can be a problem. Other people tolerate benzos better than SSRIs. Benzos can be an effective add-on to SSRIs for severe anxiety disorders. Klonopin can make depression worse (or better), depending on the individual.
Clomipramine (Anafranil) is a very potent antidepressant and anxiolytic. It is not an 'augmenting' agent, clomipramine would be your primary medication. Clomipramine tends to cause more side effects than SSRIs and is therefore not a first-line drug. If SSRIs are not effective, clomipramine could be a suitable choice. There is no doubt that clomipramine is a very strong medication.
Posted by bleauberry on February 26, 2012, at 6:55:23
In reply to Best non-MAOI for these symptoms?, posted by davidla on February 25, 2012, at 10:55:16
While any of the meds stand a chance of working, fairly random guess on any doctor's part, some might have a bit more potential for your particular presentation than others.
Just my opinion but I would stay away from effexor or cymbalta as first choices simply because if they end up being failed choices, they are some of the worst to try to get off of for most people.
The first med to pop into my mind was paxil. Any of the ssris can fit your profile, but I think paxil has an edge. I like SLS idea of adafranil, probably more side effects but good med.#4 on your list might be the most difficult to deal with because it can be a likely start-up complication with any of these meds. And if so it usually takes several weeks to resolve as the body slowly adapts and adjusts. So I think having something on board for as-needed management of irritability will be important. Personally I would turn to Lemon Balm, Passion Flower, Skullcap...in tincture form. They can all work to smooth out a wave of irritability in about 20 minutes and are healthy in other ways, non-toxic, few if any side effects other than general calming, and mix fine with most meds.
If you want to avoid the medication route altogether then look no further than Rhodiola Rosea. It has a significant likelihood of dealing with your depression in a couple weeks, sometimes starting the first day, social anxiety a week to two, OCD guessing about 3-4 weeks, and irritability a couple weeks. The trick is the dose....higher doses are generally more soothing, lower doses more stimulating.
With whatever you choose, best wishes!
Posted by Emily Elizabeth on February 26, 2012, at 23:20:19
In reply to Re: Best non-MAOI for these symptoms?, posted by bleauberry on February 26, 2012, at 6:55:23
Okay, I'm totally going to disagree with the above post. Avoid Paxil. I took it about 10 hrs ago when it was the in thing for anxiety. It was okay, but I didn't have complete success on it for anxiety and when my depression got worse, it was insufficient. Withdrawal from Paxil is awful, especially if not done slowly and carefully under the supervision of a pdoc. However, the number one reason I would avoid it is that my current pdoc (who is widely regarded to be the best in my large city) states that he never uses it anymore because of the withdrawal issue and the fact that zoloft works just as well. For what it is worth.
However, to best answer your question, it would be helpful to post your med history and what has and hasn't worked in the past.
Best,
EE
Posted by SLS on February 27, 2012, at 5:55:30
In reply to Re: Best non-MAOI for these symptoms?, posted by Emily Elizabeth on February 26, 2012, at 23:20:19
> However, the number one reason I would avoid it is that my current pdoc (who is widely regarded to be the best in my large city) states that he never uses it anymore because of the withdrawal issue and the fact that zoloft works just as well.
With antidepressants, it is not true that one drug can substitute for another in any given individual. There are plenty of people who respond to Paxil who don't respond to Zoloft. Therefore, resorting to using Paxil after several failed trials of other antidepressant drugs can be justified. If Paxil works well, and long-term treatment is indicated, why worry about withdrawal? Paxil is not an ideal drug, but neither is Tylenol.
- Scott
Posted by Emily Elizabeth on February 27, 2012, at 8:36:54
In reply to Re: Best non-MAOI for these symptoms? » Emily Elizabeth, posted by SLS on February 27, 2012, at 5:55:30
Sure, I agree with that. He does use Paxil for folks who come to him already on it or have had particular success on it in the past. I suppose my use of the term "never" was hyperbole. I was just trying to convey that as ssri's go, there are better first line options.
EE
Posted by SLS on February 27, 2012, at 8:52:10
In reply to Re: Best non-MAOI for these symptoms?, posted by Emily Elizabeth on February 27, 2012, at 8:36:54
> Sure, I agree with that. He does use Paxil for folks who come to him already on it or have had particular success on it in the past. I suppose my use of the term "never" was hyperbole. I was just trying to convey that as ssri's go, there are better first line options.
Agreed.
I had about as much difficulty discontinuing Paxil as I had with Effexor. It wasn't pleasant.
- Scott
Posted by Emily Elizabeth on February 27, 2012, at 10:57:06
In reply to Re: Best non-MAOI for these symptoms?, posted by SLS on February 27, 2012, at 8:52:10
I don't remember Effexor withdrawal one way or the other, I just remember that it made me gain over 30 lbs extremely quickly. It also did nothing for my mood. Then again, my body chemistry is very selective about what AD's it will respond to.
My fav drug hands down was abilify. When I needed to discontinue it just recently, I went for TMS. It was amazing. I think I am even better now than when I was on meds. I could do commercials for TMS.
Best,
EE
Posted by ed_uk2010 on February 27, 2012, at 14:01:38
In reply to Re: Best non-MAOI for these symptoms?, posted by Emily Elizabeth on February 27, 2012, at 8:36:54
> Sure, I agree with that. He does use Paxil for folks who come to him already on it or have had particular success on it in the past. I suppose my use of the term "never" was hyperbole. I was just trying to convey that as ssri's go, there are better first line options.
>
> EEFor me, Paxil caused more side effects and withdrawal symptoms than other SSRIs, but it did work. I think that Zoloft, Celexa and Lexapro are better first-line options.
Posted by davidla on February 27, 2012, at 17:29:30
In reply to Best non-MAOI for these symptoms?, posted by davidla on February 25, 2012, at 10:55:16
Thanks for all the input.
A little history: I was on Nardil for 15 years. But I want to try something with less severe side effects. I tried SSRIs before that but with disappointing results. Unfortunately, I don't even recall what I took!
I'm going to my doc tonight about what to try. I'll post an update. Thanks.
Posted by Phillipa on February 27, 2012, at 18:26:12
In reply to Re: Best non-MAOI for these symptoms?, posted by davidla on February 27, 2012, at 17:29:30
Looking forward to seeing what he suggested or prescribed Phillipa
Posted by davidla on February 27, 2012, at 19:48:42
In reply to Best non-MAOI for these symptoms?, posted by davidla on February 25, 2012, at 10:55:16
I'm transitioning to Parnate to see if the side effect profile is better for me than Nardil (mainly weight gain).
My doc stinks. He had no ideas. Need a new doc.
Posted by Phillipa on February 27, 2012, at 21:00:25
In reply to Re: Best non-MAOI for these symptoms?, posted by davidla on February 27, 2012, at 19:48:42
And you wanted off maois. What about emsam? Phillipa
Posted by davidla on February 27, 2012, at 21:46:13
In reply to Re: Best non-MAOI for these symptoms? » davidla, posted by Phillipa on February 27, 2012, at 21:00:25
My understanding is Emsam has not been very effective, especially for SA. That it never lived up to the hype.
Posted by Vincent_Qc on March 4, 2012, at 17:50:39
In reply to Re: Best non-MAOI for these symptoms? » Emily Elizabeth, posted by SLS on February 27, 2012, at 5:55:30
> With antidepressants, it is not true that one drug can substitute for another in any given individual. There are plenty of people who respond to Paxil who don't respond to Zoloft. Therefore, resorting to using Paxil after several failed trials of other antidepressant drugs can be justified. If Paxil works well, and long-term treatment is indicated, why worry about withdrawal? Paxil is not an ideal drug, but neither is Tylenol.
>
>
> - ScottYou're so right Scott...my experience with ssri's or srni's is that only the Paxil work for panic, general anxiety, ocd symptoms, phobias...but like you said its not a perfect drug...weight gain, extreme tiredness as well as low motivation is high with the Paxil for me but it's better than staying at home all the time and feel like I will die all the time. As for the other ssri's, I dont feel good on the Zoloft, make me less sociable, very tirred and do nothing for my type of anxiety even give panic attacks ...same for Prozac...Celexa and Lexapro are the worse on me, need to take them with stimulant meds and wellbutrin cause of the very low energy and of course do nothing for my anxiety... Effexor, cymbalta, pristiq they all make me so anxious that I just want to eat my xanax pills like candies...
I never notice any kind of withdrawal with the Paxil or the Effexor-xr, weird no? Never had problems
to stop those meds cold turkey with no brains zap or anhything else...never had difficulty before 2010 to start them and never find that they increase my symptoms at first...strangely now even in low doses like 1 mg of Paxil or 1 mg of Lexapro my symptoms increase too much and they affect mainly my heart who race so fast and my anxiety increase by 10 folds...Too bad I have too many heart symptoms to start a Maoi for now cause I find the Nardil very easy to start never notice a side effect at dose under 60 mg, but its sedative and increase the benzo meds effects who is a good thing cause each time I was on the nardil I was able to cut by half and more my clonazepam dose without tapering it and no withdrawl symptoms... anyway...old thread...just wanted to share my experience...
Posted by papillon2 on March 5, 2012, at 7:05:07
In reply to Re: Best non-MAOI for these symptoms? » SLS, posted by Vincent_Qc on March 4, 2012, at 17:50:39
> strangely now even in low doses like 1 mg of Paxil or 1 mg of Lexapro my symptoms increase too much and they affect mainly my heart who race so fast and my anxiety increase by 10 folds...Too bad I have too many heart symptoms to start a Maoi for now
I take a tricyclic anti-depressant -- which are notorious for cardiac side effects -- and I benefit greatly from the addition of Aspirin 100mg and 3g fish oil. If I stop one or both of them, the cardiac side effects (tachycardia, palpitations and chest pain) worsen. You might like to give Aspirin and fish oil a try should you resume taking a medication which gives you heart issues.
I have also found that my heart gradually became used to each dose increase over the period of a month. My resting heart rate is still roughly 25 bpm faster than usual, but I can better cope with it and I rarely have any chest pain or palpitations.
For me, having a fast heart rate feels like anxiety. This is not surprising, given that anxiety often makes one's heart beat faster. So even though I am not anxious about my heart beating so fast, I suspect I would feel less anxious if it didn't.
Posted by Vincent_QC on March 5, 2012, at 10:12:07
In reply to Re: Best non-MAOI for these symptoms? » Vincent_Qc, posted by papillon2 on March 5, 2012, at 7:05:07
> I take a tricyclic anti-depressant -- which are notorious for cardiac side effects -- and I benefit greatly from the addition of Aspirin 100mg and 3g fish oil. If I stop one or both of them, the cardiac side effects (tachycardia, palpitations and chest pain) worsen. You might like to give Aspirin and fish oil a try should you resume taking a medication which gives you heart issues.
>Great idea for the low dose of Aspirin since it's good to protect the heart from blood clots, stroke and many others cardiovasculars diseases since a fast heart rate can lead to that in long term view. I'm just worry for myself about taking the Aspirin cause my INR (coagulation time) is long and I have bleeding hemorrhoids... For the fish oil it's making me anxious, don't know why but regular Omega-3 for the heart always do that to me, the Omega-3 higher in EPA and low in DHA are ok for me but not sure they can help for the weak heart issues...?
What is your average resting pulse rate? Is it stable or can jump from 60 to 140 in less than 1 second? I can tell you than when I try the TCA's but wasnt able to stay on them for more than 1 month, the Nortriptyline was not tolerable at all with a resting pulse rate of 160 and more at only 10 mg, at the time I was a heavy coffee drinker, more than 8-10 cups a day... Also had the very fast heart beat on the Desipramine, Imipramine and Elavil but not with the Clomipramine but the clomipramine was too much for me, pins and needles effect everywhere in my body, dizziness, over sedation, cognitive problems at 50 mg I just stop thinking that I will not survive... In fact the TCA's are the only meds I wasn't able to take (with the exception of the Parnate) before the panic disorder enter in my life again...
One of my biggest problem with my heart rate is that the resting pulse rate when i'm sit can be as low as 60, most of the time 80-90 but as soon as I get up i'm dizzy and just walk in the house it's increasing to the 140 and more... when I strain for a bowel movement or strain from a physical effort or just climbing the stairs, it's start beating very fast and irregular, like I have a too strong vagal nerve action... Also my blood pressure who was normal-high (average of 140/90-95 before last june is now on the low side, mean around 100/70...when i'm more anxious the systolic decrease and the diastolic increase leading to blood pressure of 90/90...who is not normal I think but my Cardiologist seem to not think it's dangerous and just told me to drink more liquid with 10% and more of salt inside, he think I don't drink enough...
> I have also found that my heart gradually became used to each dose increase over the period of a month. My resting heart rate is still roughly 25 bpm faster than usual, but I can better cope with it and I rarely have any chest pain or palpitations.
>Normal, the body need some time to get used to the effect of the med you take...and normal that you cope better with the cardio symptoms since the med is working so no more worry...
What I find difficult is to start the med at first now... i'm so afraid of the heart symptoms that I can't... just thinking about it make me sick. I know that I will have to start it eventually and each day I told myself that I should start it but I can't...of course the more I wait and the worse it will be...
> For me, having a fast heart rate feels like anxiety. This is not surprising, given that anxiety often makes one's heart beat faster. So even though I am not anxious about my heart beating so fast, I suspect I would feel less anxious if it didn't.
Of course for me the fast heart beat is anxiety related for sure... it's just the others symptoms who make me more anxious like the dizziness, chest pain, numbness in the left arm, weird blood pressure...
Posted by Phillipa on March 5, 2012, at 18:54:10
In reply to Re: Best non-MAOI for these symptoms? » papillon2, posted by Vincent_QC on March 5, 2012, at 10:12:07
Vincent staining does effect the vagus nerve but slows down the heart rate doesn't raise it. And that can't be true having a blood pressure of 90/90. I am going to do some google searching as all your symptoms seem to be the opposite of what should happen. I just don't like this cardiologist. Phillipa
Posted by Phillipa on March 5, 2012, at 19:23:38
In reply to Re: Best non-MAOI for these symptoms? » Vincent_QC, posted by Phillipa on March 5, 2012, at 18:54:10
http://en.wikipedia.org/wiki/Gastric_bypass_surgery
Some good info. Phillipa
Posted by papillon2 on March 5, 2012, at 20:20:06
In reply to Re: Best non-MAOI for these symptoms? » papillon2, posted by Vincent_QC on March 5, 2012, at 10:12:07
> I'm just worry for myself about taking the Aspirin cause my INR (coagulation time) is long and I have bleeding hemorrhoids...
Yes, it would be best to ask your doctor first.
< For the fish oil it's making me anxious, don't know why but regular Omega-3 for the heart always do that to me, the Omega-3 higher in EPA and low in DHA are ok for me but not sure they can help for the weak heart issues...?
What do you mean by "weak heart issues"?
I get the highest EPA & DHA available, but I also make sure the ratio of EPA to DHA is high. It still helps with my heart, probably due to the number of capsules I take.
Fish oil does make some people anxious, you are not alone in that.
> What is your average resting pulse rate? Is it stable or can jump from 60 to 140 in less than 1 second? I can tell you than when I try the TCA's but wasnt able to stay on them for more than 1 month, the Nortriptyline was not tolerable at all with a resting pulse rate of 160 and more at only 10 mg,.
My resting heart rate used to be in the low 70s, now it hangs around 95bpm. Your resting heart rate of 160bpm must have felt horrible!
It was unstable when I first started Nortriptyline and again after each dose increase. The instability is no longer there, but the tachycardia has remained.
> One of my biggest problem with my heart rate is that the resting pulse rate when i'm sit can be as low as 60, most of the time 80-90 but as soon as I get up i'm dizzy and just walk in the house it's increasing to the 140 and more... when I strain for a bowel movement or strain from a physical effort or just climbing the stairs, it's start beating very fast and irregular, like I have a too strong vagal nerve action...Do you do much aerobic exercise? Exercise reduces one's resting heart rate and makes the heart rate recover more quickly after exercise.
You wouldn't need to do exercise that has you jumping up and down, resulting in blood pressure issues. A daily brisk walk for half an hour or more would do the trick.
< Also my blood pressure who was normal-high (average of 140/90-95 before last june is now on the low side, mean around 100/70...when i'm more anxious the systolic decrease and the diastolic increase leading to blood pressure of 90/90...who is not normal I think but my Cardiologist seem to not think it's dangerous and just told me to drink more liquid with 10% and more of salt inside, he think I don't drink enough...
Yeah, there's a strong link between dehydration/hyponatremia and postural hypotension, but meds can also have that effect! It's best to sit and stand up really slowly.
> What I find difficult is to start the med at first now... i'm so afraid of the heart symptoms that I can't... just thinking about it make me sick. I know that I will have to start it eventually and each day I told myself that I should start it but I can't...of course the more I wait and the worse it will be...
Not only that, all this worry will result in your heart rate increasing, etc. regardless of your medication. It is self-fulfilling.
Posted by Vincent_QC on March 10, 2012, at 10:14:22
In reply to Re: heart issues » Vincent_QC, posted by papillon2 on March 5, 2012, at 20:20:06
>
> Yes, it would be best to ask your doctor first.
>That's what I will do for the Aspirin...
>
> What do you mean by "weak heart issues"?
>I mean the constant changing in the blood pressure, getting lower when i'm very anxious OR getting higher for no reason, very slow pulse rate of 50 who jump into the 120 and more even if I do nothing and stay sit, the constant chest pain, the numbness of the left arm and upper back on the left side... things like that... for me it's not usual of a normal heart function...
>
> My resting heart rate used to be in the low 70s, now it hangs around 95bpm. Your resting heart rate of 160bpm must have felt horrible!
>When you know that you just take a med and drink coffee at the same time haing a pulse rate of 160 is not horrible, you feel more anxious but you know why you feel like that... but when you have the high heart rate for no reason or the too low heart rate and you know that you don't take meds you affect the heart and you don't eat sugar, drink coffee or soda's or anything who can increase the activity of the heart, now that's horrible...
> It was unstable when I first started Nortriptyline and again after each dose increase. The instability is no longer there, but the tachycardia has remained.
>Hummm ok... normal I guess... if you feel comfortable with the 95 pulse rate it's good then ;-)
>
> Do you do much aerobic exercise? Exercise reduces one's resting heart rate and makes the heart rate recover more quickly after exercise.
>
> You wouldn't need to do exercise that has you jumping up and down, resulting in blood pressure issues. A daily brisk walk for half an hour or more would do the trick.
>No I don't exercise cause of the malnutrition state... I had intestinal obstructions and 2 surgeries and still have problem to eat normally and have low level of vitamin so no energy, taking my shower is already enough for me to feel tired for the rest of the day...
I had a BAD experience with exercise back in 2009, I think subscribe to a gym bring back panic attacks disorder... It was the first time I was going to a gym and it was too much for me, had to deal with the too much peoples, the noise, all those machine, for someone who is anxious a gym is maybe not a good way to exercise, better to walk for sure... At the gym I was so anxious, always taking my pulse rate bring a very BAD OCD type of anxiety on me, start taking my pulse rate at home all the time and after I buy a blood pressure machine for home and start taking my blood pressure all the time and went to a downward spiral of OCD type of anxiety and focus mainly on my heart since 2009... It's now so increase in my minds that I can take my blood pressure 20 times a day and more or be sit and watch the TV and take my pulse rate without realize that I take it... I had CBT therapy for that problem and I fail to improve... I seem to be stuck with a constant worries about all the pain I feel from my body and the chronic headache, the heart and many other things like that... they call this somatization disorder I think, not sure...
>
> Yeah, there's a strong link between dehydration/hyponatremia and postural hypotension, but meds can also have that effect! It's best to sit and stand up really slowly.
>I agree with you.. I feel better when I drink less, weird no? Have less dizziness or heart problems if I drink less... will have increase headache pain and more chest pain and fast heart beat if I drink more... so I don't agree at 100% with my Cardiologist on that... I don't think i'm in a dehydration state...my urine is always clear so it's a sign that I drink enough...
>
> Not only that, all this worry will result in your heart rate increasing, etc. regardless of your medication. It is self-fulfilling.
>I know but when you feel so bad everyday and react very badly to all the meds you cannot just start an AD without thinking about the side-effects... by experience I know that for now I react to a low dose of 0.5 mg of Paxil, I can feel it and it's not in my head and it's increasing my anxiety A LOT... I can't imagine taking 10 mg at the same time, will die from it for sure... and trust me, I was used to start all the AD at high dose without any problems in the past but since 2010 I can't... my body react violently to meds...
Posted by papillon2 on March 10, 2012, at 17:17:30
In reply to Re: heart issues » papillon2, posted by Vincent_QC on March 10, 2012, at 10:14:22
> > [my heart rate] was unstable when I first started Nortriptyline and again after each dose increase. The instability is no longer there, but the tachycardia has remained.
> >
>
> Hummm ok... normal I guess... if you feel comfortable with the 95 pulse rate it's good then ;-)Comfortable would be the wrong word. It is uncomfortable, but I put up with it (and other side effects) because:
(1) my depression is treatment-resistant -- very few anti-depressants have sufficient/any anti-depressant effect for me;
(2) the only other anti-depressant which has helped recently is Remeron, which has side effects that are more unpalatable for me (weight gain, hunger, associated anxiety & risk of ED relapse) and even then it is not as effective as Nortriptyline in some ways;
(3) the alternative -- untreated/undertreated depression of a severity which is life-threatening and involves a total loss of functioning -- is not an option.If I were to write off every medication that has side effects, well, I'd either be dead or back where I started: so depressed I am unable to walk, talk, eat, drink or think about anything other than jumping in front of freight trains. That is no way to live.
Posted by Vincent_QC on March 11, 2012, at 11:07:02
In reply to Re: heart issues, posted by papillon2 on March 10, 2012, at 17:17:30
> > > [my heart rate] was unstable when I first started Nortriptyline and again after each dose increase. The instability is no longer there, but the tachycardia has remained.
> > >
> >
> > Hummm ok... normal I guess... if you feel comfortable with the 95 pulse rate it's good then ;-)
>
> Comfortable would be the wrong word. It is uncomfortable, but I put up with it (and other side effects) because:
> (1) my depression is treatment-resistant -- very few anti-depressants have sufficient/any anti-depressant effect for me;
> (2) the only other anti-depressant which has helped recently is Remeron, which has side effects that are more unpalatable for me (weight gain, hunger, associated anxiety & risk of ED relapse) and even then it is not as effective as Nortriptyline in some ways;
> (3) the alternative -- untreated/undertreated depression of a severity which is life-threatening and involves a total loss of functioning -- is not an option.
>
> If I were to write off every medication that has side effects, well, I'd either be dead or back where I started: so depressed I am unable to walk, talk, eat, drink or think about anything other than jumping in front of freight trains. That is no way to live.Hi,
I understand what you mean even if i'm not depress or never felt suicidal since the thing I fear the most is death...I think that when you find the good med(s) you have to stick with it or them even if they have side-effects. I always want to cry and feel very angry at me cause back in 2009 the Paxil was perfect for the panic disorder but I stop it cause of the weight gain!!! Big mistake, I think it's better to have 50 pounds more than to stay anxious all the time and homebound and even feel bad at home... In my case it's special for the weight gain cause I had a gastric by-pass to loose weight cause I had morbid obesity for a part of my life and the weight gain wasnt an option for me BUT now I just want to kick my head on the wall cause I stop it...anyway...
I only wanted to point out the fact that before I had no problems with meds in general...I never had problems before 2010 (well don't want also to write off every medication I try and the side-effects and the fact that the Parnate almost kill me 3 times but well now meds who had near 0 side-effect on me in the past are impossible to take again, I know fears and anxiety can make the side-effects 10000000 worse, but I think it's something else on me, something change in my brains and my body since I never felt that way in the past and I guess I will never know what happen really with me, a little bit hopeless, being stuck in a public health system lead to long waiting list to see specialist Docs and have tests to rull out possible real diseases, probably POST (postural tachycardia) with reactive hypoglicemia, bad blood supply on the body who lead to chronic chest pain, numbness of left arm, headache, dizziness, jaw and neck pain, blueish hands and feet, extreme fatigue, insomnia, IBS-D, name them, have so many symptoms who can be linked to real disease that it's hard to imagine that it's only anxiety related, it can be that... I never see or hear a story about someone who had somatic complaints about digestive problems with bloating, pain and constipation who lead to 1 intestinal obstruction + 1 bile duck obstruction and 2 surgeries to recover and still have the same digestive symptoms... anxiety can't do that...that's what I think...and I don't dramatize here, that's what I live each day...
Don't think that I just want to stay untreated or take meds cause I fear them...I stay in a kind of untreated state cause I can't cope with the increase anxiety the meds are giving to me that's it... I already feel like I will die all the time with the so many symptoms I have each day and adding a med, who at 10% of the regular dosage, will send me to the emergency room ( Lexapro 2,5 mg back in january 2010 with synusal tachycardia... even if I took it at 40 mg back in 2008 with no problem) is not an option even if I know that a med without side-effect is almost impossible to find, I think that one day my Doc will find the good med for me or the good combo... For now the best I can do is to continue to take my 8 mg of Klonopin + 0.25 mg of Xanax + 10 mg of Valium each day with no success to decrease my anxiety and just stuck with addiction and rebound anxiety.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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