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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by ben on June 12, 2001, at 14:01:48
Does anyone have good experiences with paxil for melancholic depression (low mood) ?
My doc wants to put me on Paxil after
I tried Surmontil (150 mg), Effexor (150 mg), Celexa (100 mg), Zoloft (75 mg); all with limited success. That means I had to stop them because of side effects or too less of effectiveness. Now I am taking 6 mg Edronax for two weeks with limited effect besides some side effects (increased heart rate, impotence, urinary retention). Does this side effects fade away ?
Posted by Elizabeth on June 12, 2001, at 22:58:32
In reply to PAXIL-success stories for melancholia ???, posted by ben on June 12, 2001, at 14:01:48
> Does anyone have good experiences with paxil for melancholic depression (low mood) ?
I might be confused about what you're saying, but "melancholia" actually defines a specific symptom cluster; it doesn't mean sad or low mood. SSRIs may be less effective for this subtype of depression than tricyclics (although the evidence is inconclusive). Remeron and Effexor are supposed to be effective, and MAO inhibitors probably are also although they have been studied less in this condition. I'm not sure about Edronax, but I'd give it more of a chance.
If you had partial responses to other medications, perhaps combination therapy would be the way to go? I also note that some of the doses you listed seemed a bit odd. 100 mg of Celexa is pretty high while 75 mg of Zoloft is kind of low. 150 mg of Effexor is a decent dose but many people need before, and Effexor does generally work better the more you raise the dose (unlike SSRIs, which generally plateau at a certain dose).
The side effects you mentioned should get milder with time, BTW.
-elizabeth
Posted by ben on June 13, 2001, at 3:58:10
In reply to Re: Paxil for melancholia » ben, posted by Elizabeth on June 12, 2001, at 22:58:32
> > Does anyone have good experiences with paxil for melancholic depression (low mood) ?
>
> I might be confused about what you're saying, but "melancholia" actually defines a specific symptom cluster; it doesn't mean sad or low mood. SSRIs may be less effective for this subtype of depression than tricyclics (although the evidence is inconclusive). Remeron and Effexor are supposed to be effective, and MAO inhibitors probably are also although they have been studied less in this condition. I'm not sure about Edronax, but I'd give it more of a chance.
>
> If you had partial responses to other medications, perhaps combination therapy would be the way to go? I also note that some of the doses you listed seemed a bit odd. 100 mg of Celexa is pretty high while 75 mg of Zoloft is kind of low. 150 mg of Effexor is a decent dose but many people need before, and Effexor does generally work better the more you raise the dose (unlike SSRIs, which generally plateau at a certain dose).
>
> The side effects you mentioned should get milder with time, BTW.
>
> -elizabeththanks for your reply elizabeth
100 mg Celexa was true, 75 mg of Zoloft was too much because of persisiting nausea, 150 Effexor was too much for my head (2 month with headache). For me melancholia means very low mood (all the time crying); but your definition is the right one. I had combinations with these drugs and others (antipsychotics) and never reached stability in my mood. I failed of Lithium cause of awful nausea (in combo with 100 mg Celexa !!!). Remeron at 7.5 mg was too sedating and i felt stoned.
ben
Posted by Mitch on June 13, 2001, at 12:22:13
In reply to Re: Paxil for melancholia, posted by ben on June 13, 2001, at 3:58:10
> > > Does anyone have good experiences with paxil for melancholic depression (low mood) ?
> >
> > I might be confused about what you're saying, but "melancholia" actually defines a specific symptom cluster; it doesn't mean sad or low mood. SSRIs may be less effective for this subtype of depression than tricyclics (although the evidence is inconclusive). Remeron and Effexor are supposed to be effective, and MAO inhibitors probably are also although they have been studied less in this condition. I'm not sure about Edronax, but I'd give it more of a chance.
> >
> > If you had partial responses to other medications, perhaps combination therapy would be the way to go? I also note that some of the doses you listed seemed a bit odd. 100 mg of Celexa is pretty high while 75 mg of Zoloft is kind of low. 150 mg of Effexor is a decent dose but many people need before, and Effexor does generally work better the more you raise the dose (unlike SSRIs, which generally plateau at a certain dose).
> >
> > The side effects you mentioned should get milder with time, BTW.
> >
> > -elizabeth
>
> thanks for your reply elizabeth
> 100 mg Celexa was true, 75 mg of Zoloft was too much because of persisiting nausea, 150 Effexor was too much for my head (2 month with headache). For me melancholia means very low mood (all the time crying); but your definition is the right one. I had combinations with these drugs and others (antipsychotics) and never reached stability in my mood. I failed of Lithium cause of awful nausea (in combo with 100 mg Celexa !!!). Remeron at 7.5 mg was too sedating and i felt stoned.
> benBen, I think Elizabeth is right about the tricyclics. I have a very touchy gut and get nauseated really easily with the meds you just listed. Maybe nortriptyline or desipramine (something not too sedative)? Plus AD's that work on norepinephrine/dopamine might be better for your "melancholia". Have you tried any Wellbutrin?
Mitch
Posted by ben on June 13, 2001, at 12:36:57
In reply to Re: Paxil for melancholia » ben, posted by Mitch on June 13, 2001, at 12:22:13
> > > > Does anyone have good experiences with paxil for melancholic depression (low mood) ?
> > >
> > > I might be confused about what you're saying, but "melancholia" actually defines a specific symptom cluster; it doesn't mean sad or low mood. SSRIs may be less effective for this subtype of depression than tricyclics (although the evidence is inconclusive). Remeron and Effexor are supposed to be effective, and MAO inhibitors probably are also although they have been studied less in this condition. I'm not sure about Edronax, but I'd give it more of a chance.
> > >
> > > If you had partial responses to other medications, perhaps combination therapy would be the way to go? I also note that some of the doses you listed seemed a bit odd. 100 mg of Celexa is pretty high while 75 mg of Zoloft is kind of low. 150 mg of Effexor is a decent dose but many people need before, and Effexor does generally work better the more you raise the dose (unlike SSRIs, which generally plateau at a certain dose).
> > >
> > > The side effects you mentioned should get milder with time, BTW.
> > >
> > > -elizabeth
> >
> > thanks for your reply elizabeth
> > 100 mg Celexa was true, 75 mg of Zoloft was too much because of persisiting nausea, 150 Effexor was too much for my head (2 month with headache). For me melancholia means very low mood (all the time crying); but your definition is the right one. I had combinations with these drugs and others (antipsychotics) and never reached stability in my mood. I failed of Lithium cause of awful nausea (in combo with 100 mg Celexa !!!). Remeron at 7.5 mg was too sedating and i felt stoned.
> > ben
>
> Ben, I think Elizabeth is right about the tricyclics. I have a very touchy gut and get nauseated really easily with the meds you just listed. Maybe nortriptyline or desipramine (something not too sedative)? Plus AD's that work on norepinephrine/dopamine might be better for your "melancholia". Have you tried any Wellbutrin?
> Mitch
I should not taking any tricyclics because I had a heart operation. My electrocardiogramm could be a problem with the tricyclics (sometimes they increase the QT-time).
Ben
Posted by Elizabeth on June 13, 2001, at 16:50:39
In reply to Re: Paxil for melancholia, posted by ben on June 13, 2001, at 12:36:57
> I should not taking any tricyclics because I had a heart operation. My electrocardiogramm could be a problem with the tricyclics (sometimes they increase the QT-time).
That's true: tricyclics can be dangerous for people with certain cardiac conditions. MAOIs used to be the ADs of choice for people who couldn't take tricyclics because of cardiovascular disease. Since the newer ADs don't seem to be helpful for you, MAOIs might be worth a try.
One thing about Remeron: it tends to be less sedating at higher doses. If you didn't do this before, you might try starting it at 30 mg.
-elizabeth
Posted by Elizabeth on June 14, 2001, at 14:05:00
In reply to Re: Paxil for melancholia, posted by ben on June 13, 2001, at 12:36:57
BTW -- here are the diagnostic criteria for "melancholic features" in a major depressive episode:
A. Either of the following, occurring during the most severe period of the current episode:
(1) loss of pleasure in all, or almost all, activities
(2) lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)B. Three (or more) of the following:
(1) distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)
(2) depression regularly worse in the morning
(3) early morning awakening (at least 2 hours before usual time of awakening)
(4) marked psychomotor retardation or agitation
(5) significant anorexia or weight loss
(6) excessive or inappropriate guilt(_Diagnostic and Statistical Manual of Mental Disorders_, 4th ed. American Psychiatric Association 1994)
Posted by JohnL on June 16, 2001, at 5:01:12
In reply to PAXIL-success stories for melancholia ???, posted by ben on June 12, 2001, at 14:01:48
> Does anyone have good experiences with paxil for melancholic depression (low mood) ?
> My doc wants to put me on Paxil after
> I tried Surmontil (150 mg), Effexor (150 mg), Celexa (100 mg), Zoloft (75 mg); all with limited success. That means I had to stop them because of side effects or too less of effectiveness. Now I am taking 6 mg Edronax for two weeks with limited effect besides some side effects (increased heart rate, impotence, urinary retention). Does this side effects fade away ?It's just my opinion and my own personal experience, but I do not think SSRIs are good for melancholic depression. There are plenty of clinical studies that indicate SSRIs are good for melancholia, but in the real world I just don't see it very often.
For melancholia my favorite drugs are Prozac+Zyprexa+Adrafinil. It took me years and years to find this combination, but I'm glad I found it because it completely wiped out my longstanding dysthymia and I feel better than ever before in my life.
Paxil and other SSRIs can actually make melancholia worse, through a numbing of emotions. The last thing a melancholic person needs is to have emotions numbed even more. But that's what SSRIs do. The one exception many times is Prozac, which is quite unique from the other SSRIs in a lot of ways. Add some Zyprexa and Adrafinil to it, and it's magic. For me anyway.
John
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