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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Jack Smith on March 3, 2003, at 12:32:28
OK, here's the situation. . . .
I suffer from depression/GAD with some atypical features (hypersomnia, leaden paralysis). I experienced an almost total remission from Celexa for about a year and a half and then it pooped out. Added Wellbutrin, helped but didn't really get me far (about 50% normal now). So, anyway, I have finally weaned myself off Celexa in about two weeks time--almost NO withdrawls.
So the question is this: My pdoc suggests that I try Effexor but is willing to give me Parnate. I know the conventional wisdom is that I should probably try Effexor first since I have only really tried three drugs (Paxil--OK but total sedation, WB and Celexa). BUT I know that an MAOI would work on my symptoms. I think Effexor has a good shot of working and I would be willing to give it a full 3 month trial working my way up to 225 (where there is a norepinephrine effect). I am just worried that if it doesn't work, it will take me months to get off and then I will have to suffer for quite some time before I try Parnate.
It is a crucial time now, I can wait two weeks and go to Parnate or I could try Effexor. What do people think? Any advice helpful.
JACK
Posted by Jack Smith on March 3, 2003, at 19:36:03
In reply to EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by Jack Smith on March 3, 2003, at 12:32:28
Posted by stjames on March 3, 2003, at 19:54:32
In reply to EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by Jack Smith on March 3, 2003, at 12:32:28
> I suffer from depression/GAD with some atypical features (hypersomnia, leaden paralysis).
Provided you are willing to follow the MAOI
diet, I would go for Parnate. MAOI's are good for atypical depression.I think Effexor is a good choice, too, but you do have valid conserns about having to commit to Effexor for an extended time.
You can always try it if parnate does not work.
Keep in mind, not following the correct diet could
lead to serious problems and even death, with most MAOI's.
Posted by MelD on March 3, 2003, at 21:46:25
In reply to Re: EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effex, posted by stjames on March 3, 2003, at 19:54:32
Its a tough call for you Jack, but from my own experience i would say go for the Parnate sooner than later. I have depression with symptoms similar to yours and spent years resisting my docs recommendation to go with an MAOI. I used different SSRIs over nearly 20 years: Prozac, Zoloft, Celexa, Effexor, Serzone, and all eventually pooped out on me or i could not tolerate a big enough dose to knock out my symptoms. I first tried Parnate and promise you it is a "kick ass" med with fast results, or it was in my case anyway. I had to stop taking it when the anxiety got to be too much to handle. I think i will eventually give it another try, though, because there were other factors that may have messed up my reaction to the drug, but the the effect on my mood was wonderful - i never felt such relief on anything else. Right now i am taking Nardil and having some problems with side effects also, but i am digressing (babbling even?) Anyway, the upshot is that i think Parnate is worth the try and it probably wont take a long trial for you to know if it is right for you. Best of luck with whatever you decide.
Posted by Ritch on March 3, 2003, at 23:44:53
In reply to EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by Jack Smith on March 3, 2003, at 12:32:28
> OK, here's the situation. . . .
>
> I suffer from depression/GAD with some atypical features (hypersomnia, leaden paralysis). I experienced an almost total remission from Celexa for about a year and a half and then it pooped out. Added Wellbutrin, helped but didn't really get me far (about 50% normal now). So, anyway, I have finally weaned myself off Celexa in about two weeks time--almost NO withdrawls.
>
> So the question is this: My pdoc suggests that I try Effexor but is willing to give me Parnate. I know the conventional wisdom is that I should probably try Effexor first since I have only really tried three drugs (Paxil--OK but total sedation, WB and Celexa). BUT I know that an MAOI would work on my symptoms. I think Effexor has a good shot of working and I would be willing to give it a full 3 month trial working my way up to 225 (where there is a norepinephrine effect). I am just worried that if it doesn't work, it will take me months to get off and then I will have to suffer for quite some time before I try Parnate.
>
> It is a crucial time now, I can wait two weeks and go to Parnate or I could try Effexor. What do people think? Any advice helpful.
>
> JACK
What about a Prozac trial instead of the Effexor? If you got "near total remission" from Celexa that seems to indicate an SSRI would help. I got more anti-ADD effect from Prozac at low-doses than I do with Effexor at low-doses. I don't know why, but I felt more alert on fluoxetine. I take a tiny bit of Effexor now, but at low doses it helps anxiety much more than depressive symptoms. OTOH, Prozac at low-doses was energizing.
Posted by SLS on March 4, 2003, at 6:53:05
In reply to EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by Jack Smith on March 3, 2003, at 12:32:28
Hi Jack.
> I suffer from depression/GAD with some atypical features (hypersomnia, leaden paralysis).> I experienced an almost total remission from Celexa for about a year and a half and then it pooped out.
> So the question is this: My pdoc suggests that I try Effexor but is willing to give me Parnate.
> I know the conventional wisdom is that I should probably try Effexor first since I have only really tried three drugs (Paxil--OK but total sedation, WB and Celexa).
I think Mitch (Ritch) has focused on an important point - you ARE responsive to SSRIs. Effexor (venlafaxine) is sort of a like a combination of SSRI + TCA. That you are resonsive to SSRIs leads me to believe that Effexor has a pretty good chance of working without poop-out (tachyphylaxis). A recent study of over 2000 patients demonstrated that Effexor has a somewhat higher rate of producing an antidepressant response than SSRIs, and has a much lower rate of pooping-out than SSRIs (probably similar to TCA).
> BUT I know that an MAOI would work on my symptoms.
An MAOI might work. It might not.
You may want to take into consideration the side-effects that you have experienced with Paxil and Celexa. Were of such magnitude that you would want to try another class of drugs on that basis alone? If so, pehaps now would be the time to try an MAOI.
> I think Effexor has a good shot of working and I would be willing to give it a full 3 month trial working my way up to 225 (where there is a norepinephrine effect).
You MUST try at least 300mg. This is really the sweet-spot for severe, recurrent, or chronic depression.
> I am just worried that if it doesn't work, it will take me months to get off and then I will have to suffer for quite some time before I try Parnate.
Effexor has a short half-life (5-7 hrs for venlafaxine; 11 hrs for active metabolite). In their package insert ,the manufacturer suggests waiting 7 days from the last dose before initiating a trial of MAOI. (For the reverse switch, 14 days is prudent when changing from an MAOI to Effexor - especially with Nardil). This shouldn't take any more than 3 weeks to accomplish.
> It is a crucial time now, I can wait two weeks and go to Parnate or I could try Effexor. What do people think? Any advice helpful.
I don't want to make a recommendation, but I hope this information helps you to arrive at a decision.
Good luck. I think you can look forward to achieving a remission, even though you might guess wrong for your first choice.
- Scott
Posted by missinglynxx on March 4, 2003, at 7:27:20
In reply to Re: EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by SLS on March 4, 2003, at 6:53:05
Its sort of has been established that Remeron can work much Faster than an SSRI,, maybe you might feel better within 2 weeks rather than 4 weeks. They use it alot in Europe (since Organon that company that manufactures it is in Belgium)
I cant personally attest to its affectiveness since I just started 1 0 days ago. BUT the initial sedation is Bizarre....
Im finding the initial sedation is down 70 percent :PLus its a mild drug overall, It doesnt knock the Sox offa you legs... at least in my opinion.. and we all prefer a loveable Side effects profile!!
Posted by jumpy on March 4, 2003, at 15:41:13
In reply to EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by Jack Smith on March 3, 2003, at 12:32:28
Hey Jack,
I would try a different class of medications like the TCAs first. Imipramine has been shown to be effective for both GAD and atypical depression ... but with the side effects, maybe nortriptyline or desipramine would be better.
If that didn't work, I would move on to an MAOI like parnate.
Jumpy
Posted by Jack Smith on March 4, 2003, at 16:37:07
In reply to Re: EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by SLS on March 4, 2003, at 6:53:05
> I think Mitch (Ritch) has focused on an important point - you ARE responsive to SSRIs. Effexor (venlafaxine) is sort of a like a combination of SSRI + TCA. That you are resonsive to SSRIs leads me to believe that Effexor has a pretty good chance of working without poop-out (tachyphylaxis). A recent study of over 2000 patients demonstrated that Effexor has a somewhat higher rate of producing an antidepressant response than SSRIs, and has a much lower rate of pooping-out than SSRIs (probably similar to TCA).
>Scott, Ritch (Mitch?) or others,
I tend to agree with you guys that Effexor is probably the better alternative at this stage in the game. BUT do you guys think that the fact that an ssri worked and then pooped out means that other ssri's won't work (granted Effexor is an snri as well as an ssri) or do you think it means that another ssri has a better chance of working since I have previously responded well to one? I know that everyone is different but what are your thoughts/opinions? By the way, Mitch, the reason why I am not thinking of prozac is that its half life is too long so if I did switch to an MAOI, I'd probably have to wait quite a while.
Thanks in advance,
JACK
Posted by medlib on March 4, 2003, at 18:34:25
In reply to Scott, Ritch--Questions, posted by Jack Smith on March 4, 2003, at 16:37:07
Hi Jack--
I've been on Effexor since I joined PB, about 3 1/2 yrs. I began E. when Prozac pooped out for me after many years. So, prior SSRI poop out does not preclude success with Effexor. I've augmented E. with just about everything; it makes a good base for that kind of tinkering, if E. itself isn't quite enough. Currently, I'm taking it w. Wellbutrin, which works pretty well. E. is activating for many, so help sleeping may be required; it certainly is for me.
I had a bad experience with an MAOI years ago, and, given my addiction to aged cheddar cheese and an occasional glass of wine, I'd probably do myself in on one now. They *do* have a good track record w. atypicals, tho; I'm seriously considering trying the selegiline patch when it becomes available. It seems like a much less hazardous MAOI alternative with smoother delivery and fewer SEs. 1 PBer was in on the clinical trials and *really* liked it.
What if you knew beforehand that Parnate and Effexor would work equally well for you? Which one would you want to be on long term?
Good luck with your decision!---medlib
Posted by stjames on March 4, 2003, at 22:37:20
In reply to Re: EXP'NCED P'BABLRS PLS:dont forget Remeron , posted by missinglynxx on March 4, 2003, at 7:27:20
> Its sort of has been established that Remeron can work much Faster than an SSRI,, maybe you might feel better within 2 weeks rather than 4 weeks.
I would be intrested in reading whatever
indicates this is "established".j
Posted by stjames on March 4, 2003, at 22:41:36
In reply to Re: Effexor » Jack Smith, posted by medlib on March 4, 2003, at 18:34:25
> What if you knew beforehand that Parnate and Effexor would work equally well for you? Which one would you want to be on long term?
This is a good way of sorting things out, excellent idea, medlib.
Posted by Ritch on March 4, 2003, at 23:02:16
In reply to Scott, Ritch--Questions, posted by Jack Smith on March 4, 2003, at 16:37:07
> > I think Mitch (Ritch) has focused on an important point - you ARE responsive to SSRIs. Effexor (venlafaxine) is sort of a like a combination of SSRI + TCA. That you are resonsive to SSRIs leads me to believe that Effexor has a pretty good chance of working without poop-out (tachyphylaxis). A recent study of over 2000 patients demonstrated that Effexor has a somewhat higher rate of producing an antidepressant response than SSRIs, and has a much lower rate of pooping-out than SSRIs (probably similar to TCA).
> >
>
> Scott, Ritch (Mitch?) or others,
>
> I tend to agree with you guys that Effexor is probably the better alternative at this stage in the game. BUT do you guys think that the fact that an ssri worked and then pooped out means that other ssri's won't work (granted Effexor is an snri as well as an ssri) or do you think it means that another ssri has a better chance of working since I have previously responded well to one? I know that everyone is different but what are your thoughts/opinions? By the way, Mitch, the reason why I am not thinking of prozac is that its half life is too long so if I did switch to an MAOI, I'd probably have to wait quite a while.
>
> Thanks in advance,
>
> JACKGiven that you don't want to wait a long time for a med washout it tends to tilt things to the short acting meds like Effexor for a trial. I felt the most alertness from Prozac and Celexa (out of the heavy serotonergic meds). Zoloft, Paxil, Luvox, and even Effexor tends to tire me quite a bit (at the low-doses I can tolerate). I just mentioned Prozac because it seems to be a different animal from the other SSRI's and there seems to be a significant alerting effect the others don't seem to have (it's the ONLY SRI that actually helps my ADD sx). It was my favorite-but it was just so harsh on my gut (but it isn't the only one). If you can tolerate fairly high doses of serotonergic AD's Effexor might be the best bet for you right now.----Mitch
Posted by ace on March 5, 2003, at 3:51:31
In reply to EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by Jack Smith on March 3, 2003, at 12:32:28
Posted by stjames on March 5, 2003, at 11:25:48
In reply to EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by Jack Smith on March 3, 2003, at 12:32:28
http://www.dr-bob.org/babble/20030301/msgs/205428.html
Do read this post about MAOI's and some foods.
Posted by Jack Smith on March 5, 2003, at 13:10:28
In reply to Re: EXP'NCED P'BABLRS PLS:dont forget Remeron , posted by stjames on March 4, 2003, at 22:37:20
> > Its sort of has been established that Remeron can work much Faster than an SSRI,, maybe you might feel better within 2 weeks rather than 4 weeks.
>
> I would be intrested in reading whatever
> indicates this is "established".
>
> jIt has been established . . . in their advertising.
Posted by Jack Smith on March 5, 2003, at 13:14:06
In reply to Re: Effexor » Jack Smith, posted by medlib on March 4, 2003, at 18:34:25
What dose are you on? How quickly did you make the switch from prozac to effexor, from what dose to what dose? Also, why the augmentation? I am definitely going to continue wellbutrin if I do the switch to Effexor, just so I can at least keep some stability.
On more important question--what was your bad experience with an MAOI and which one??? (also are you atypical?)
Sorry for all the questions but I can assure you that your answers will help me.
JACK
Posted by stjames on March 5, 2003, at 16:50:40
In reply to Re: EXP'NCED P'BABLRS PLS:dont forget Remeron , posted by Jack Smith on March 5, 2003, at 13:10:28
> It has been established . . . in their advertising.
>Advertising is not clinical proof.
There has yet, in 50 years been an AD that works
quicker than 4 weeks for the general population.
Many claim, not produce.
Many on this list confuse initial effects with the true AD effect.
Posted by Jack Smith on March 5, 2003, at 17:13:09
In reply to Re: EXP'NCED P'BABLRS PLS:dont forget Remeron , posted by stjames on March 5, 2003, at 16:50:40
I agree with everything you say. My remarks were a joke. . . . .
It's funny how they really still haven't found an AD that works in less than 4 weeks (8 weeks for me, always) because there is still no real explanation for why this is, a bunch of theories but no one can really say why. . . .
> > It has been established . . . in their advertising.
> >
>
> Advertising is not clinical proof.
> There has yet, in 50 years been an AD that works
> quicker than 4 weeks for the general population.
> Many claim, not produce.
> Many on this list confuse initial effects with the true AD effect.
Posted by stjames on March 5, 2003, at 18:36:31
In reply to Re: EXP'NCED P'BABLRS PLS:dont forget Remeron » stjames, posted by Jack Smith on March 5, 2003, at 17:13:09
> I agree with everything you say. My remarks were a joke. . . . .
>
> It's funny how they really still haven't found an AD that works in less than 4 weeks (8 weeks for me, always) because there is still no real explanation for why this is, a bunch of theories but no one can really say why. . . .AH ! I see.
Reuptake inhibition happens almost at once after taking an AD. If that fixed mood we would see a change at once. It seems by changing one thing (reuptake) we cause the system to seek a new level. This is what takes so long.
Given the comlpexity of mood and the CNS (or just NS) it is unreasonable to think any change would happen quickly. Or to look at it another way,
till we understand the comlpex process we will not have more specific agents that work quickly.Or another way to look at it is the one does not get depressed at once so it is unreasonable to expect recovery to be quick.
Posted by matt66 on March 6, 2003, at 15:48:32
In reply to Re: EXP'NCED P'BABLRS PLS:dont forget Remeron , posted by stjames on March 5, 2003, at 16:50:40
> > It has been established . . . in their advertising.
> >
>
> Advertising is not clinical proof.
> There has yet, in 50 years been an AD that works
> quicker than 4 weeks for the general population.
> Many claim, not produce.
> Many on this list confuse initial effects with the true AD effect.i may be one of those who confused initial effects with the true anti-depressant effect. i was depressed for + 10 years, but so functional and able to hide it, that even my psychiatrist father didn't recommend i try ad's until I was 18 (about four years ago). we raced through a few tca's (i've ben in college and the pressure and impatience made it impossible to sit on a med). eventually i tried marplan for a week (no effect), and then nardil, and within 48 hours I was a different person completely. social anxiety/self-consciousness/self-loathing/inferiority complex/nervousness all went away. in their place- increadible levels of creativity, confidence/sucess with girls/peaceful mind/ actually noticing the effect of my positive vibes on other people rather than that feeling of awkwardness people would have around me due to the deprerssed vibe i was sending out. increased energy, focus, sense of humor- i couldn't have dreamed a med could do all that. i didn't even realize how bad i had it till i came out of the fog. but, after three weeks, i felt it slipping. i was able to recall how i felt initially and act out the role/personality i experienced on the nardil and was in a better spot than before (probably from having had so many insights on the nardil and therefore gaining a different perspective on life). however, three weeks of remission plus another couple weeks of residual effects, and i had to tell my doc it wasn't working. i was on 45mg at the time (i'm a 21 year old, 250lb male). we immediately jumped to the parnate rather than increasing the nardil, with no luck. granted almost all my trials over the past three 1/2 years have been cut short because I expected an immediate response like on the nardil, and couldn't face the idea of waiting to feel better. now I'm on selegiline (eldypryl) and plan on giving it and all future trials six weeks no matter how shitty they make me feel at first. in the last three years, I've had a few creative breakthroughs, but no AD effect. i tried the nardil again, this time at 90 mg and after two weeks, my parents visited, and i couldn't look them in the eyes- i was totally withdrawn, a zombie. i wanted to try it for six weeks, even though it seemed to be having a paradoxical reaction, but i think it really scared my parents, and so now i'm on seleligine. my pdoc is top notch, very liberal, willing to try anything aggressively, which is how i like it since side effects mean nothing to me when weighed up against the possibility of a therapeutic effect. you could chop off my balls if i was promised a lifetime of feeling like I did on the nardil. please explain what you mean by "initial effects without a true anti-depressant effect" as this seems to fit my case perfectly. my doc says the nardil just simply pooped out (tachyphylaxis) and although it gave me initial remission, is not the med for me. problem is, I haven't felt ANYTHING from any med or 15 ect treatments since. recently i developed the theory that since i was depressed for so long, my body reacted to a foreign chemical almost immediately, but as soon as it became used to it, the drug no longer worked. i take this theory partially from my experiences smoking pot. if i don't smoke for a while, I'll get real creative/more social/lose some anxiety that first time i puff. but if i try it again the next day, i'll feel next to nothing. Please provide me with any insight you may have, as knowing what it feels like to not be depressed has made these past three years a living hell. i almost wish i never experienced the nardil feeling, so I wouldn't know what I was missing. however, there has to be some explanation. do you think if I stayed on the nardil this second time for six weeks, the withdrawal/nervousness/brain deadness would go away? why did it seem to work and now give me paradoxical reactions? (on 90mg, twice the dose i was on when it worked and bummed out). after the selegiline, i plan on trying parnate again, but this time for six weeks. having teirs everything, i now feel that i didn't give any of the meds enough time to kick in, and since I (seemed to) respond to the nardil, this could bode well for an extended parnate trial. sorry for the length- I would greatly appreciate your opinion, as the mystery had plagued me for years, expecially since I had everything I wanted in my grasp and have tried everything to get it back unsucessfully.
This is the end of the thread.
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