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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 mambo on April 9, 2003, at 7:08:23
I have had depression for six years now, and last year I was diagnosed with bi-polar after having a manic episode. I have been taking sodium valporate for about 11 months and coming off it now. I am also taking effexor, but the problem I am having is a real lack of motivation and fatigue does any one no any other anti depressants that can help this. + does anyone know anything that is good for anxiety?
Posted by falconman on April 9, 2003, at 7:49:56
In reply to what helps motivation and fatigue?, posted by mambo on April 9, 2003, at 7:08:23
Hi,
A more stimulating AD that works more specifically on dopaminergic/noradrenergic systems may help to combat fatigue/motivation.
Have you tried an MAOi eg Parnate, Nardil. Also Selegiline(deprenyl)augmented with DL-Phenylalanine might really work well, and with this there shouldn't be the dietry restrictions or as many side effects that apply to the other MAOi's.
Nardil is also very efficiant at getting rid of anxiety, as part of its action is on the GABA system. Benzo's such as valium or Klonopin maipulate GABA and work extremely well for anxiety. I take Klonopin myself. Some of the more stimulating Anti-depressants may increase anxiety, therefore a small dose of Klonopin taken alongside for eg. Selegiline could also be very effective.
However I have only experience with depression/anxiety and not of bi-polar, therefore these suggestions might not be appropriate.
Take care
Mark
Posted by mambo on April 9, 2003, at 9:26:14
In reply to Re: what helps motivation and fatigue?, posted by falconman on April 9, 2003, at 7:49:56
Hi Mark,
thanks for the reply, are MAOI's addictive, if not what is the difference between those and SSRI's are they more effective in relieving depression, I was diagnosed with bi-polar, but they are not entirely sure because they think that the manic episode may have been caused by stress ans smoking weed. (Which I havent smoked since (1 year). I dont have any other signs of manic depression either so who knows? I have had long term depression which I find totally annoying, and I am finding extremely hard to shift.
Cheers
Andy
Posted by falconman on April 9, 2003, at 19:13:02
In reply to Re: Thanks for the advice but are..., posted by mambo on April 9, 2003, at 9:26:14
> Hi Mark,
>
> thanks for the reply, are MAOI's addictive, if not what is the difference between those and SSRI's are they more effective in relieving depression, I was diagnosed with bi-polar, but they are not entirely sure because they think that the manic episode may have been caused by stress ans smoking weed. (Which I havent smoked since (1 year). I dont have any other signs of manic depression either so who knows? I have had long term depression which I find totally annoying, and I am finding extremely hard to shift.
>
> Cheers
> AndyHi Andy,
MAOI's are not addictive, they just work in a different way to SSRI's. The idea behind all antidepressants is to increase the availability of certain chemicals (neurotransmiters) in parts of the brain. These are released into small 'gaps' between cells in the nervous system where they act to aid communication between cells. After a neurotransmiter (eg. Seretonin, dopamine, neuradrenaline)has been used a significant amount is reabsorbed back from the 'gap' into a cell from where it was released, or broken down. The idea is to interfere with one of these processes in some way so that chemicals stay in the 'gap' for longer therefore increasing their availability and ability to communicate.
Selective seretonin reuptake inhibitors (SSRI's) block seretonin from being re-absorbed back into a cell, whereas MAOI's stop seretonin, neuradrenaline and dopamine from being broken down. So both types of antidepressants increase the amount of neurotransmiters in the 'gap', they just go about it in different ways and effect different types.
Alot of people can try several different SSRI's with limited/no success. MAOI's can often help these people alot and be much more effective, but are rarely used as a first line of therapy. This is because potentially they can be dangerous if they interact with certain foods eg. mature cheeses. If you follow certain dietry restrictions and keep to the reconmended dose they are very safe to use.
If SSRI's are the only antidepressants you've tried it could be a good idea to try a different type like an MAOI. There are actually many other pharmacological avenues that could help also, and you shouldn't have to put up with long term resistant depression!
Although this is very simplistic, symptoms such as lack of drive/motivation/sex drive/numbness are often associated more with a lack of dopamine and neuradrenaline rather than seretonin. Therefore considering the symptoms you said your experiencing, and because you haven't found satisfactory relief from an SSRI, it seems reasonable that taking a drug which will increase levels of dopamine and/or neuradrenaline could give you much better results.
There are several people on this message board that found SSRI's completely inaffective and have been 'rescued' by an MAOI.
Peace
Mark
Posted by falconman on April 9, 2003, at 19:31:00
In reply to Re: Thanks for the advice but are..., posted by falconman on April 9, 2003, at 19:13:02
Hi,
I just read your original message, and realised that you are taking effexer, not an SSRI. Effexer does effect levels of neuradrenaline and at high doses dopamine. However it won't effect dopamine levels as much as other drugs, and works very differently to an MAOi. I would still talk to your doc about the possability of an MAOi trial, it could really turn things around for you.
Good Luck
Posted by mambo on April 10, 2003, at 5:54:42
In reply to Re: Thanks for the advice but are..., posted by falconman on April 9, 2003, at 19:13:02
Hi mark,
Thanks for the advice it sounded useful and I will definatly look into it. yeah your right about putting up with long term depression, no one should have to put up with it. I am suprised that no doctors have suggested trying MAOI's especially if they are not addictive. I've suffered with depression for so long Ive forgotten what it would be like to feel normal.
Cheers
Andy
Posted by MelD on April 10, 2003, at 9:40:39
In reply to Re: Thanks for the advice but are..., posted by mambo on April 10, 2003, at 5:54:42
I just wanted to add my 2cents here and tell you i had a similar history to yours and have finally found relief on an MAOI. Wish i had listened to my doc and taken it years ago. Best of Luck.
Posted by mambo on April 10, 2003, at 10:02:18
In reply to Re: Thanks for the advice but are..., posted by MelD on April 10, 2003, at 9:40:39
Thanks Mel it's good to here that people have managed to come through a difficult illness.Andy
This is the end of the thread.
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