Psycho-Babble Medication Thread 396870

Shown: posts 1 to 14 of 14. This is the beginning of the thread.

 

Stimulating Antidepressants

Posted by Hervé on September 29, 2004, at 14:11:07

Hi.

I suffer from an 19 years old (I'm 37) dysthymia with recurring major depressions. I don't suffer from anxiety (except a little social anxiety because I overeact to rejections). The prominents aspects of my depression are low drive and motivation, permanent fatigue and fog brain (except when over-focused), concentration difficulties. For making short, I'm apathic. In fact I strongly suspect an innatentive/limbic ADD.

I'm currently (since 3 months, first psy medication in my life) on sertraline (zoloft) but an SSRI is clearly not the solution for me. During my next appointment with my MD, I will ask to switch to another class.

From the drugs approved for depression in France, I consider three as suitable :
- Desipramine
- Moclobemide
- Viloxazine

Witch one is the more stimulating ? the better in regard of sexual functions ? in regard of cognitive function ? Other comments ?

Thanks.

 

Re: Stimulating Antidepressants

Posted by jlbl2l on September 29, 2004, at 15:48:58

In reply to Stimulating Antidepressants, posted by Hervé on September 29, 2004, at 14:11:07

ritalin my friend

 

Re: Stimulating Antidepressants

Posted by Hervé on September 29, 2004, at 16:32:48

In reply to Re: Stimulating Antidepressants, posted by jlbl2l on September 29, 2004, at 15:48:58

> ritalin my friend

Yes of course.

Alas, Ritalin and concerta are approved in France only for ADHD. But it's a long quest to be diagnosticated as ADHD. Many think it's an imaginary desease. ADHD specialists are few. Hyperactives childs are underdiagnosticated. Those with inatentive type or adults are more heavily underdiagnosticated.
Ritalin and Concerta are very controlled substances. A prescription for it can only be made by an hospital specialist. My MD is not allowed to prescribe it to me.
It will take perhaps some years before I have acccess to Ritalin or Concerta.
So for present an antidepressant acting on norepinerphine is the best I can obtain (among them reboxetine and strattera are not available, nor bupropion). But what are the pro and con for the three available here ?

 

Re: Stimulating Antidepressants

Posted by jlbl2l on September 29, 2004, at 16:40:24

In reply to Re: Stimulating Antidepressants, posted by Hervé on September 29, 2004, at 16:32:48

i dont know of those 3, sorry man. a really good french antidepressant is survector. as your doctor for that, it is THE BEST.

 

Re: Stimulating Antidepressants » Hervé

Posted by Racer on September 29, 2004, at 17:53:37

In reply to Stimulating Antidepressants, posted by Hervé on September 29, 2004, at 14:11:07

Moclobimide is not available in the US, so I can't say anything about it.

Desipramine certainly has a lot of supporters, and it's at the top of the list of drugs I wish I could tolerate -- lowers my already low blood pressure too much, which is a pretty common problem for me, even from meds that aren't known for it. I can't tell you whether or not it was stimulating, since I couldn't manage more than a few days on it. (And I should also note: some meds I find sedating stimulate others...) Nortriptyline, though, gave me a pretty good ride some years back.

I'm not familiar with Viloxazine, so can't answer that one, either.

Here are a couple of other options to consider, if you have access:

Venlafaxine -- Effexor in the US -- which acts on both NE and 5HT. There's good and bad said about it, but it can be very effective.

Cymbalta, which probably isn't available there yet.

Or augmenting an AD with something like Modafinil, which is a non-stimulant "focus enhancer" -- really, a mildly stimulating agent that doesn't have the drawbacks of real stims.

Not much to offer, but I wanted to mention the Modafinil. Good luck.

 

Re: Stimulating Antidepressants

Posted by Hervé on September 30, 2004, at 2:12:23

In reply to Re: Stimulating Antidepressants, posted by jlbl2l on September 29, 2004, at 16:40:24

> A really good french antidepressant is survector. ask your doctor for that, it is THE BEST.

Yeah it seems to be. Alas it is no longer available (since 1999). It's a pity that I didn't search medical aid for my depressive state before because I could have it from 19 years old to 32 years old. My life would have be very different.

 

Re: Stimulating Antidepressants

Posted by Hervé on September 30, 2004, at 2:24:17

In reply to Re: Stimulating Antidepressants » Hervé, posted by Racer on September 29, 2004, at 17:53:37

> Venlafaxine -- Effexor in the US -- which acts on both NE and 5HT. There's good and bad said about it, but it can be very effective.

Well. I suffer from sexual side-effects with Sertraline/Zoloft so I didn't consider it as suitable.

> Cymbalta, which probably isn't available there yet.

Yes. I have no doubt that it will be available in the future. Lily have suffisently of money and commercial aggressivity to make his products approoved in every countries. It will be a possibility because his side effects seams lesser than effexor. (Or is it just marketing by Lily ?).

> Or augmenting an AD with something like Modafinil, which is a non-stimulant "focus enhancer" -- really, a mildly stimulating agent that doesn't have the drawbacks of real stims.

Modafinil is as controled than Ritalin. It's only prescribed by an hospital specialist for narcolepsy with catalepsy. But adrafinil (whom modafinil is a metabolite) is a normal prescription drug. It's approved for cognitive decline of aged patients but can be freely prescribed by any doctor.

I will follow your council and will attempt in a second time to have it for augmenting an antidepressant when I will have discover the one what is the best for me.

Thanks

 

Re: Stimulating Antidepressants » jlbl2l

Posted by theo on September 30, 2004, at 7:06:39

In reply to Re: Stimulating Antidepressants, posted by jlbl2l on September 29, 2004, at 15:48:58

Which is better, Ritalin or Adderall?

 

Re: Stimulating Antidepressants » Hervé

Posted by Racer on September 30, 2004, at 12:06:08

In reply to Re: Stimulating Antidepressants, posted by Hervé on September 30, 2004, at 2:24:17

I understand your reluctance to take something known for sexual side effects, since I've experienced them, too. Have you tried mitigating them, rather than trying to avoid drugs that might cause them?

When I took Effexor, I did experience anorgasmia, but my doctor prescribed an old anti-histimine called cyproheptidine, which fixed it for me. It works for some people, not for others. Basically, it blocks the serotonin receptors temporarily, so the sexual side effects go away for as long as the drug is working. Once the drug wears off, the anti-depressant goes back to working normally. In other words, it counter-acts the sexual side effects, but only as long as the cyproheptidine is working. That's about four hours, not enough to interfere with the anti-depressant treatment.

If it's the choice between having to plan ahead for sex, so that you can take a little pill twenty or thirty minutes ahead of time, or not treating the depression, I choose the cyproheptidine and treating the depression. That's a personal choice, though, that everyone needs to make based on personal priorities.

I do hope that information helps, though, and I'm sorry things are so limited for you. That's very rough.

 

Re: Stimulating Antidepressants

Posted by TheOutsider on September 30, 2004, at 13:48:23

In reply to Re: Stimulating Antidepressants, posted by Hervé on September 29, 2004, at 16:32:48

My dear Herve I live in the UK and also probably have ADHD inattentive type.

You are lucky that Adrafanil is available in France. I ordered it over the internet and it significantly improved my symptoms, I was on a dose of 3 tablets a day.
The major side effect for me was insomnia, with some irritability.
Unfortunatly I have currently run out and am surviving on a dwidiling stock of dexedrine!

 

Re: Stimulating Antidepressants

Posted by jlbl2l on September 30, 2004, at 15:13:37

In reply to Re: Stimulating Antidepressants » jlbl2l, posted by theo on September 30, 2004, at 7:06:39

everything is better than ritalin so ive heard. i believe most people agree... dexedrine...adderall....ritalin in that order of goodness.

 

Re: Stimulating Antidepressants

Posted by Hervé on October 2, 2004, at 6:58:51

In reply to Re: Stimulating Antidepressants » Hervé, posted by Racer on September 30, 2004, at 12:06:08

> I understand your reluctance to take something known for sexual side effects, since I've experienced them, too. Have you tried mitigating them, rather than trying to avoid drugs that might cause them?
> When I took Effexor, I did experience anorgasmia, but my doctor prescribed an old anti-histimine called cyproheptidine, which fixed it for me.

I didn't experience only anorgasmia but low libido and erection dysfunction too. I tried to mitigate with cyproheptadine, yohimbe, Gingko Biloba, Arginine and Indian generic bupropion.
No success with the first three. Arginine helps. But sexual side effects are not my only reason for wanting a switch from a drug acting on 5HT to a drug acting on NE.

>I'm sorry things are so limited for you. That's very rough.

Yes, on 23 drugs approved in France as antidepressants, 9 are sedating, 10 intermediate and only 4 are stimulating.
If you have a depression with anxiety and insomnia you have plenty of choices, but if you have depression with asthenia and inhibition the choices are more resticted.

 

Re: Stimulating Antidepressants

Posted by pablo1 on October 4, 2004, at 20:36:28

In reply to Re: Stimulating Antidepressants, posted by Hervé on September 30, 2004, at 2:12:23

Can you get amisulpride? At low doses it acts as a stimulant for some and there are studies showing it's effectiveness for depression.

 

Re: Stimulating Antidepressants

Posted by Hervé on October 5, 2004, at 11:26:42

In reply to Re: Stimulating Antidepressants, posted by pablo1 on October 4, 2004, at 20:36:28

> Can you get amisulpride? At low doses it acts as a stimulant for some and there are studies showing it's effectiveness for depression.

Yes. But I don't know if my MD will be wanting to prescribe it. He is not a specialist in psychopharmacology so he is more used to prescribing SRI with a benzodiazepine to a just divorced person than treating a twenty years old chronic depression with a cocktail of on- and off-label drugs.

But I know that's a standard in french psychiatry to augment antidepressant with carpipamine (prazinil) or a low dose of a benzamide like amilsupride (solian) in case of dysthymia with inhibition.

I don't worry about complementary drugs. Are available :
- thyroidian hormones
- adrafinil
- amilsupride/carpipramine

What I can't decide for is the principal drug : desipramine, moclobemide or viloxazine.
I think I must experiment each to discover what is the best for me.
I see my MD tomorow. So I suppose that I will obtain the one the most familiar to him.


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