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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Josh37 on July 20, 2004, at 21:01:11
Hi there. I have trouble adjusting to most antidepressants. The newer SSRI's give me severe GI tract disturbances. Prozac makes me completely apathetic. Tricyclics, including desipramine, either make me tired and/or give me BPH (prostate inflammation). Effexor made me nautious and tired, as did Lexapro. Wellbutrin made me break out in hives. Dexedrine amped me, but did not help with my depression, in addition to which, I don't want to take anything physically addictive. Currently, I self-medicate (with caffeine in the morning), and alternate between neurontin, percocet, ambien and klonopin at night. I feel like I am out of control and abusing substances, but I just feel terrible such a large portion of the time. My doctor said he might try me on Mirapex (a dopamine agonist used for Parkinson's) or Lamictal. Can someone help me or give me advice? Thanks.
Posted by King Vultan on July 21, 2004, at 7:58:04
In reply to Multiple Intolerances to Antidepressants, posted by Josh37 on July 20, 2004, at 21:01:11
The Mirapex might actually be worth trying, but dopamine agonists are notorious for causing nausea and somnolence. I've considered trying to badger my pdoc into letting me try it, but I thought it more sensible and conservative to try the MAOIs first. Currently, I'm taking Nardil, and it's very likely that I will also try Parnate at some point, perhaps sooner than later.
Todd
Posted by Josh37 on July 21, 2004, at 10:20:34
In reply to Re: Multiple Intolerances to Antidepressants, posted by King Vultan on July 21, 2004, at 7:58:04
Todd--just wondering, how are the MAOI's working out for you? Are the dietary restrictions a pain in the ass? What are some other side effects?
-Josh
> The Mirapex might actually be worth trying, but dopamine agonists are notorious for causing nausea and somnolence. I've considered trying to badger my pdoc into letting me try it, but I thought it more sensible and conservative to try the MAOIs first. Currently, I'm taking Nardil, and it's very likely that I will also try Parnate at some point, perhaps sooner than later.
>
> Todd
Posted by King Vultan on July 21, 2004, at 12:11:38
In reply to Re: Multiple Intolerances to Antidepressants, posted by Josh37 on July 21, 2004, at 10:20:34
> Todd--just wondering, how are the MAOI's working out for you? Are the dietary restrictions a pain in the ass? What are some other side effects?
>
> -Josh
>
The dietary restrictions are really not that annoying for me, but some of the actual side effects of the Nardil have been a problem. The insomnia was a big problem at first, but alternating between Halcion one night and Benadryl the next, plus using a sleep/relaxation CD, has pretty much cured that problem. The biggest continuing problem has been the lowering of heart rate and blood pressure, and I've come close to fainting several times. One plus is that I have borderline hypertension (140/90) and was able to dump my BP medication. Another common side effect of Nardil is delayed orgasm, but this is actually a plus in my case (and frankly one of the reasons I was interested in the drug). For the average person, however, for which this may be a problem, this can be extremely difficult to treat.As for therapeutic effects, my opinion is that Nardil is an effective antidepressant and is very good in particular for social anxiety/social phobia. Unfortunately, it's becoming apparent my problem is rooted in anhedonia more than anything else, and this is why I'm thinking the Parnate, which is much more dopaminergic, might be a better choice. Parnate also has much fewer side effects in general compared to Nardil, and I believe it would likely be more tolerable and more effective than a dopamine agonist. However, the dopamine agonists are very easy to try compared to an MAOI, and as I said, I have considered it myself.
Todd
Posted by Racer on July 21, 2004, at 14:02:14
In reply to Multiple Intolerances to Antidepressants, posted by Josh37 on July 20, 2004, at 21:01:11
Ugh, this is a problem I can certainly relate to, although my problems with most of the anti-depressants I've tried have been a little more limited: worst from an objective standpoint is hypotension, worst subjectively is weight gain, with anorgasmia running a close second (although this would really only matter if I had a sex life), and a few other bothersome problems running in a pack somewhere behind those.
As for 'fixing' the problem of intolerance, I'm not sure what the answer is. It's a subject I struggle with a lot, and the closest I've come to an answer for myself is that I'm gonna have to put up with a certain amount of discomfort in order to treat the depression. Sounds kinda easy, huh? (NOT) My situation is a little complicated, because I am relying on a very, very broken county system for treatment, so I can't test my theory that adequate support from the doctor in getting through the adjustment phase might allow me to tolerate the adverse effects of the drugs, but that is my theory. I hope that, once I get to play with the Big Boys and see a doctor in more optimal circumstances, I'll be able to address the issue of reassurance and support, and thereby get through the adjustment phase and *finally* get adequate relief from my depression. That might be something to think about for you, too.
A lot of the side effects, by the way, are alleged to fade away once your body adjusts to the new medications. It's possible that the problems you've been having will go away if you can gut them out for a few weeks. (In my case, that hasn't been possible with some drugs, because the adverse effects have been too dangerous in and of themselves: ranging from frequent fainting, to increased suicidal impulsivity, to one experience where I actually threatened my husband! Sometimes gutting it out just ain't in the cards, but if you are able, it might be worth a try.)
If you have a good rapport with your pdoc, you could discuss ways to mitigate some of the adverse effects of the meds, too. Some effects can be lessened, although some just cannot.
Other than those thoughts, not much else I can offer, except to say that augmenting the meds with therapy can also be helpful in getting through some of the adjustment problems.
It might help, though, if you give a full list here of the meds you've tried. There are a lot of very well informed people here, and some of them seem to know more about alternative medications than a lot of doctors. If they know the specifics, they may be able to see something you haven't tried.
Posted by hok on July 22, 2004, at 15:00:58
In reply to Re: Multiple Intolerances to Antidepressants » Josh37, posted by King Vultan on July 21, 2004, at 12:11:38
Todd
As for Nardil, I was wondering if you experience any agitation on it. I get slight akathesia/restlessness from the SSRIs and SNRIs. I was wondering if you could provide a comparison with your experience with Nardil. thanks
HOK
> > Todd--just wondering, how are the MAOI's working out for you? Are the dietary restrictions a pain in the ass? What are some other side effects?
> >
> > -Josh
> >
>
> The dietary restrictions are really not that annoying for me, but some of the actual side effects of the Nardil have been a problem. The insomnia was a big problem at first, but alternating between Halcion one night and Benadryl the next, plus using a sleep/relaxation CD, has pretty much cured that problem. The biggest continuing problem has been the lowering of heart rate and blood pressure, and I've come close to fainting several times. One plus is that I have borderline hypertension (140/90) and was able to dump my BP medication. Another common side effect of Nardil is delayed orgasm, but this is actually a plus in my case (and frankly one of the reasons I was interested in the drug). For the average person, however, for which this may be a problem, this can be extremely difficult to treat.
>
> As for therapeutic effects, my opinion is that Nardil is an effective antidepressant and is very good in particular for social anxiety/social phobia. Unfortunately, it's becoming apparent my problem is rooted in anhedonia more than anything else, and this is why I'm thinking the Parnate, which is much more dopaminergic, might be a better choice. Parnate also has much fewer side effects in general compared to Nardil, and I believe it would likely be more tolerable and more effective than a dopamine agonist. However, the dopamine agonists are very easy to try compared to an MAOI, and as I said, I have considered it myself.
>
> Todd
Posted by King Vultan on July 22, 2004, at 17:17:33
In reply to Re: Multiple Intolerances to Antidepressants » King Vultan, posted by hok on July 22, 2004, at 15:00:58
> Todd
>
> As for Nardil, I was wondering if you experience any agitation on it. I get slight akathesia/restlessness from the SSRIs and SNRIs. I was wondering if you could provide a comparison with your experience with Nardil. thanks
>
>
> HOK
>No, I don't experience any agitation on Nardil and really don't from SSRIs or SNRIs, either, so I appear to not be sensitive to that particular side effect. The main side effect that I suffer on both SSRIs and SNRIs--as well as MAOIs--is insomnia, particularly, waking up and not being able to get back to sleep. However, while on the Nardil, which has been by far the worst one that way, I've put a lot of work into combating the problem and now have much more effective countermeasures.
Todd
Posted by ravenstorm on July 22, 2004, at 19:05:55
In reply to Re: Multiple Intolerances to Antidepressants » hok, posted by King Vultan on July 22, 2004, at 17:17:33
Josh
Remeron does not cause nausea, in fact it blocks nausea. But it can be very sedating for some (ME!). It is a lot easier to start on than an SSRI, but weight gain is common. I have NOT gained any weight on it, but it is a constant struggle.
Posted by Josh37 on August 1, 2004, at 18:06:03
In reply to Re: Multiple Intolerances to Antidepressants » hok, posted by King Vultan on July 22, 2004, at 17:17:33
Just wanted to say thanks to everybody for their responses. Much appreciated. Any additional info would be great.
Josh
Posted by mockturtle on September 2, 2004, at 15:56:51
In reply to Re: Multiple Intolerances to Antidepressants, posted by Josh37 on August 1, 2004, at 18:06:03
Josh,
I have been very resistant to SSRIs and have recently been put on Mirapex for dopamine effects and Neurontin for sleep. I will let you know how it works out.Best
> Just wanted to say thanks to everybody for their responses. Much appreciated. Any additional info would be great.
>
> Josh
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