Psycho-Babble Medication Thread 16692

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Please help me with medication suggestions

Posted by Pat on December 11, 1999, at 11:14:24

I've written to this board before, but not for a while. I've taken lots of SSRI's, but they didn't help, upset my stomach and kept me awake. They also caused sexual side effects. I had been on triavil (tricyclic) for a long time, which helped me sleep and worked on the depression somewhat, but made me relentlessly constipated to the point where I had to had a couple operations because of it. I tried serzone, but it made me psychotic and scared, I tried remeron, I gained 12 pounds in ten days. I tried wellbutrin SR finally and it seemed to help me. After the first couple of weeks, my anxiety lessened and my depression was better. No other side effects. Then the constipation came back, just like the triavil. Relentless. My pdoc said I need the type of medication that affects the dopamine, not the seratonin. But, he said, all the medications that affect the dopamine will constipate me. He is now at the point where he is saying I'm at the end of the list of medications. Can this be true?

 

Re: Please help me with medication suggestions

Posted by Elizabeth on December 11, 1999, at 21:44:11

In reply to Please help me with medication suggestions, posted by Pat on December 11, 1999, at 11:14:24

> I had been on triavil (tricyclic) for a long time, which helped me sleep and worked on the depression somewhat, but made me relentlessly constipated to the point where I had to had a couple operations because of it.

Oof...I'm sorry. FWIW, there are other tricyclics, such as desipramine, that have fewer side effects. In order to get the tricyclic-antipsychotic combo effect you'd take one of them with a separate antipsychotic (Triavil is amitriptyline (Elavil) plus the antipsychotic perphenazine (Trilafon)). Or you could take amoxapine (Asendin), which is a tricyclic that has both antidepressant and antipsychotic effects. Some of the newer antipsychotics, such as Zyprexa, Risperdal, and Seroquel, might be better than perphenazine.

> My pdoc said I need the type of medication that affects the dopamine, not the seratonin. But, he said, all the medications that affect the dopamine will constipate me.

I don't think that's true. Anyway, Triavil has a different sort of effect on dopamine than Wellbutrin does.

> He is now at the point where he is saying I'm at the end of the list of medications. Can this be true?

Nope. :)

 

Re: Please help me with medication suggestions

Posted by JohnL on December 12, 1999, at 4:54:40

In reply to Please help me with medication suggestions, posted by Pat on December 11, 1999, at 11:14:24

Hi Pat. There are plenty of options. It would be nice if we could just have one drug in the medicine cabinet. But for many of us that just isn't realistic. We either need a second or third drug to potentiate the primary antidepressant, or, we often need a drug to counteract the most problematic side effect. In your case, treating the constipation secondary to the depression sounds like a very high priority.

If the pdoc cannot help treat the constipation, perhaps another specialist can. Having said that, the drug Bethanecol might be helpful. It is a cholinergic drug used to counteract the anticholinergic side effects of tricyclics. Even a small amount of Lithium might do the trick.

Other suggestions:
Return to the Wellbutrin, treat the constipation, perhaps with Bethanecol.
Return to a tricyclic, add Bethanecol. Nortriptyline and Desipramine have milder side effects than Triavil.
Get a prescription for Amisulpride (a dopaminergic drug) from an overseas pharmacy. It's a friendly drug, and your pdoc shouldn't resist much if he/she thinks you're running out of options (which you aren't).
But if you've had fair response to Wellbutrin and Triavil, it would make sense to refocus on those but make the constipation treatment a top priority as well.

Have you seen Dr Bob's "tips" section? If not, click on "tips" at the top of the main page. Then, after it takes you there, go down to the search box, leave it blank, and click on the search button. The vast amount of tips and tricks from doctors around the world is staggering. You'll realize just how wrong your pdoc is. Talk about options. I've never tried it, but if you type constipation in the search box there might be some tips on that topic. Don't know.

Many of us end up with doctors who just aren't up to speed on their homework. We have two options: 1)Find a new doc who knows all the tricks, 2)Take it upon ourselves to engage in research and become our own best second opinion. If the doc thinks there are no more options, you might have to do your own homework, print out your research to show him/her, and put a little pressure on him/her to do some homework, get more creative. Make your own suggestions, backed up with printed proof. Very simply it seems if you could treat the antidepressant induced constipation you would be all set. There must be a way to do that. Best wishes for you. JohnL


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