![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Roman on September 2, 2002, at 16:51:22
Greetings,
I'm new here. Have been reading/learning a great deal from all of you--it's fantastic--Bravi!
I seek advice/experience on starting an AD, and hope some of you will assist me in deciding which way to go.
Here's my hx:
40 y/o male, average weight, good health, good diet, regular exercise, no other drugs/supplements (aside from SAMe) currently being taken.
Moderately depressed/anxious for several years. Depression deepened by relationship break-up early 2001. Anxiety increased significantly along with depression. Mood somewhat improved over time but far from enjoying life.
- Tried Paxil: Lasted a few weeks due to zombie-like feelings and insomnia. Some relief of depression. Nasty stuff.
- Tried Serzone: Did not feel right (spaced-out) after first dose--discontinued. Also not willing to risk liver damage.
- Traditional Psychotherapy: For six months--somewhat helpful, not cured by any means.
- Prescribed Wellbutrin but decided not to take them--concerned with seizure risk and tendency to induce anxiety.
- Started taking SAMe six weeks ago. Started at 400mg/dy now at 100mg or 200mg/dy. Takes the edge off depression, but makes me feel jittery and a little high most of the day. Still far from happy and quite anxious.
Considering the following ADs (in order of preference):
Lexapro: Concerned with insomnia, fatigue, and weight gain. I understand no AD is side-effect free, yet Lexapro/Celexa seem comparatively safe/mild. Lexapro has a particularly attractive s/e profile.
Celexa: Same concerns as above. Since I'm sensitive to medications, think it might be easier to start at very low dose of Celexa (easier to cut tabs) as opposed to Lexapro, and titrate slowly to therapeutic dose.
Zoloft: Understand it's more potent than Celexa/Lexapro, but heard many success stories--especially interested in its effect on Social Phobia and GAD. Don't like the fact that it's hard to kick.
Effexor: Also good for my Social Phobia/GAD + Depression. Concerned about it being too activating and harder to kick than Celexa/Lexapro.
Remeron: Sounds okay but can't afford to be heavily sedated during the day--maybe worth a try or in combo with another AD.
My GP doesn't like benzos and thinks an SSRI would be best in my case. I haven't been to a pdoc yet, but considering it. GP will prescribe ADs but doesn't know much about them.
Benzos knock me out but are life savers when insomia hits.
Also thinking of continuing on SAMe since it is somewhat helpful and may reduce required dosage of AD--I've read posts about combining SAMe and pharm ADs--any reason not to start by adding AD to current SAMe dosage?
Very sick of being down and uptight all the time. I'm sure a better life through chemistry is a possibility. Although I know drugs are not perfect, they can helpful. It's worth the risk of side-effects at this point.
I look forward to your suggestions.
Thanks,
Roman
Posted by Bill L on September 3, 2002, at 8:47:15
In reply to Need Help Deciding Which AD to Start/Add to SAMe , posted by Roman on September 2, 2002, at 16:51:22
OK. Here's my 2 cents worth of advice:
1) Stick to your GP right now. If things don't improve over time, then switch to a pdoc later.
2) I have taken SAM-e in the past alone and had the same experience as you. It helped, but not enough. I stopped SAM-e and just take Celexa with very good results. It is OK to take SAM-e with other meds. But once you find something that works, I think you will be fine without the SAM-e.
3) I agree that Wellbutrin can induce jittery feelings. It had that effect on me. But it does relieve anxiety in some people. Actually, a lot of this depends on what people mean by these words. Lots of antidepressants relieve "worrying" but at the same time increase "jitteriness". Also, I wouldn't worry about Wellbutrin's seizure risk if you start at a low dose and increase it
gradually.4) You said that you are afraid of Zoloft being hard to kick. That is not really a major problem with Zoloft. For example, Paxil and Effexor are harder to kick than Zoloft. But even with Paxil and Effexor, if you gradually decrease the dose, and maybe add some Prozac, qiutting should not be too bad.
I think that your idea of trying Lexapro is a good idea. I will switch to Lexapro later this week when it comes out. I have had good success with Celexa for both my extreme anxiety and my major depression. I take 60 mg of Celexa. In trials, 10 mg of Lexapro have been as effective as 40 mg of Celexa. I'll probably start with 15 mg of Lexapro, then go up or down.
I really don't see any reason for you to start with Celexa instead of Lexapro. If I were you, I would try 10 mg Lexapro. You could start with 5 mg and then increase it.
Hopefully it will work. But if not, don't be afraid of trying Zoloft, Effexor, Wellbutrin, or Remeron. If you read enough posts on the internet, you are bound to find horror stories about any depression drug. In reality, with proper management, these drugs are nothing to be afraid of. Good luck!
Posted by BarbaraCat on September 3, 2002, at 13:38:17
In reply to Need Help Deciding Which AD to Start/Add to SAMe , posted by Roman on September 2, 2002, at 16:51:22
Hi Roman, and welcome to our board. It's a pleasure to meet someone as articulate and introspective as you. Seeing your symptoms and what you've tried laid out so clearly helps most of us on this board to understand each other and ourselves a little better.
What it sounds like you're after is a little more zip and social ease without the side effects of anxiety. Zoloft was a very good drug for me in that respect, although it started plateauing at one year. I also had a flattening emotional response from it and little interest in sex. All this was still a big relief from anxiety, which zoloft took away as if by magic. I'd been on all the others you mentioned with much of the same effects. My current one is Remeron, but I can't really recommend it. At first it was wonderful, the best AD I'd ever had, but now it's settled into a yuck kind of place, even with all the augmenting from mood stabilizers. I'm very interested in Lexapro because of the hype I've read here and elsewhere. It seems promising. All I'm really looking for is something that allows me to get up and moving and exercising which leads me to other good and interesting things. So far, all the meds have their own set of problems. BTW, I'm also taking SAM-e 400mg. Hate to go any higher because of potential hypomanic episode.
Posted by Roman on September 4, 2002, at 13:09:13
In reply to Re: Need Help Deciding Which AD to Start/Add to SAMe » Roman, posted by BarbaraCat on September 3, 2002, at 13:38:17
Bill L:
Thanks for the info; it's exactly what I was looking for. I contacted my GP and asked for Lexapro--should have it by tomorrow (if my pharmacy actually gets a shipment).
I'll post my experiece with "the new kid on the AD block" and keep the fingers crossed for all of us.
As you suggested, I'll try another med if Lex doesn't do the trick (prob Zoloft). Your comments helped relieve some of the anxiety I had about starting another SSRI.
BarbaraCat:
Thanks for the warm welcome. I look forward to sharing experiences and information with all of you. You hit the nail on the head with what I'm looking for from a med, and I must admit, "...a flattening emotional response... and little interest in sex" wouldn't be too bad a thing right now. I'll keep Zoloft as a second try if Lex doesn't come through.
I found SAMe to induce hypomania at dosages higher than 100mg bid. Additionally, the higher dosages don't do much more for my depression. I notice a difference between the 1,4-butanedisulphonate and the tosylate preparations: both are effective, but the tosylate seems a bit weaker and wears-off faster--the former is smoother. However, there are so many variables, my observations are hardly scientific.
Thanks again,
Roman
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.