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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by FredPotter on September 7, 2005, at 15:38:10
I have inner restlessness, a sort of grinding of opposing forces inside me. I also have to fight off sleep all day. I therefore sleep excessively. I don't see any point in anything. I take lithium, Celexa 60mg and Zyprexa 2.5 mg. Can anyone recommend a better regime? I'd like to wash all the Celexa out and do a trial with Nardil or Selegeline. Do you think that's a good idea?
Many thanks
Fred
Posted by woolav on September 7, 2005, at 18:10:33
In reply to what's the best treatment for agitated depression?, posted by FredPotter on September 7, 2005, at 15:38:10
Fred, what is your dx? I dont understand why you would be on lithium and zyprexa for depression. And personally i think those two meds are whats the problem for you, not the celexa. I was on a similar combo years ago ( except add depoke) I too was given this for major depression. Well, i had soo many side effects and weirdness, that i stopped taking all the meds and never saw that pdoc again. Unless you have BP I dont know if that combo is right. Maybe someone else here will shed light on what meds would be right for you.
S
Posted by Phillipa on September 7, 2005, at 18:50:43
In reply to Re: what's the best treatment for agitated depression?, posted by woolav on September 7, 2005, at 18:10:33
Only comment I have is why does every one want to go on nardil? Fondly, Phillipa
Posted by Meri-Tuuli on September 8, 2005, at 5:36:11
In reply to Re: what's the best treatment for agitated depression?, posted by Phillipa on September 7, 2005, at 18:50:43
Hey!
I have been on celexa (by itself) and it made me really sleepy all day. and no motivation.
Can't say about the others through.
Meri
x
Posted by SLS on September 8, 2005, at 7:32:54
In reply to what's the best treatment for agitated depression?, posted by FredPotter on September 7, 2005, at 15:38:10
Hi Fred.
Tricyclics have been used to treat agitated depression in the past. It might be worthwhile giving one a try. Nortriptyline seems like the the best choice because of its milder side effects. Most people do well at 75mg. A gradual titration might help avoid an infrequent increase in anxiety or insomnia that can come in the beginning of treatment. Some people, on the other hand, feel calmer almost immediately. You might not need a particularly sedating tricyclic (amitripyline, doxepin, trimipramine) if you continue to use Zyprexa.
> I have inner restlessness, a sort of grinding of opposing forces inside me. I also have to fight off sleep all day. I therefore sleep excessively. I don't see any point in anything. I take lithium, Celexa 60mg and Zyprexa 2.5 mg. Can anyone recommend a better regime? I'd like to wash all the Celexa out and do a trial with Nardil or Selegeline. Do you think that's a good idea?
I think Nardil would be the better choice. It is more serotonergic (anti-obsessional) and GABAergic (anxiolytic). For now, I would try to maintain the Zyprexa.
- Scott
Posted by Chairman_MAO on September 8, 2005, at 23:56:34
In reply to Re: what's the best treatment for agitated depression?, posted by SLS on September 8, 2005, at 7:32:54
I agree with SLS. Nardil is probably the best choice; isocarboxazid is also an option.
Posted by Jedi on September 9, 2005, at 3:09:40
In reply to Re: what's the best treatment for agitated depression?, posted by Phillipa on September 7, 2005, at 18:50:43
> Only comment I have is why does every one want to go on nardil? Fondly, Phillipa
Hi Phillipa,
Being on and off Nardil several times, I think I can answer your question. After someone has tried 25 or 30 combinations of medications that do not work, I believe they would risk anything, even death, for the chance to feel good again. Nardil is one of those meds that for atypical depression with anxiety, it works, when nothing else will. For treatment resistant atypical depression, it will still work on 75 or 80 percent of the people who give it a honest trial. Nardil is the gold standard for atypical depression, social and generalized anxiety. In my opinion it should be the 2nd med. tried for these conditions. Not the 10th. Every time I've come off Nardil in the past 10 years, my major depression has returned. There is some danger, but not as much as treatment resistant chronic depression.
Take Care,
Jedi
Posted by phillipa on September 9, 2005, at 21:14:20
In reply to Re: what's the best treatment for agitated depression? » Phillipa, posted by Jedi on September 9, 2005, at 3:09:40
I'd try it really I would but my doc wouldn't prescribe it and I don't know any that would. I've had depression and anxiety since my hypothyroidism began and no meds have worked. Either in the beginning I was too afraid to stick out side effects but now nothing touches me. I tried the nortriptaline but pdoc said to stop it as it was interracting with another med I'm taking. Now wouldn't you think a pdoc should know what interractions would occurr before prescribing a med? I'm just fed up with pdocs that don't know what they're doing. Fondly,Phillipa
Posted by FredPotter on September 11, 2005, at 15:52:59
In reply to Re: what's the best treatment for agitated depression? » Jedi, posted by phillipa on September 9, 2005, at 21:14:20
Thanks for the replies. I was on Marplan years ago and the only things I can remember are weight gain and anorgasmia. Is this a problem with Nardil? How does Selegiline compare with it?
Posted by Jedi on September 12, 2005, at 1:12:04
In reply to Re: what's the best treatment for agitated depression?, posted by FredPotter on September 11, 2005, at 15:52:59
> Thanks for the replies. I was on Marplan years ago and the only things I can remember are weight gain and anorgasmia. Is this a problem with Nardil? How does Selegiline compare with it?
Hi Fred,
Nardil has similar side effects as Marplan. At high doses it can cause anorgasmia. At lower doses it will cause some delay in ejaculation. Weight gain is a big one with Nardil. I really have to exercise a lot to keep the weight off. As I mentioned before, however, there is nothing as bad as serious treatment resistant depression. Including weight gain and lack of orgasm. Nardil works for atypical depression and social anxiety where other medications have failed.I have never used Selegiline. From my study of the medication, at low doses it only affects MOA-B which doesn't do much for depression. At higher doses it affects MOA-A and MOA-B. This is similar to Nardil, Marplan and Parnate, with the same food and drug restrictions. Maybe when the patch is approved, it will be worth a try.
Take care and be well,
Jedi
Posted by denise1966 on September 12, 2005, at 8:44:04
In reply to what's the best treatment for agitated depression?, posted by FredPotter on September 7, 2005, at 15:38:10
.
Posted by PrettyLady on March 1, 2013, at 21:58:17
In reply to Re: what's the best treatment for agitated depression?, posted by Phillipa on September 7, 2005, at 18:50:43
I was on Nardil for 6 months and it never worked, it was a really tough time for me. I took Celexa on it's own also, and that made me very tired and lethargic, so that makes sense. You say you're hypothyroid, are you taking thyroid replacement? The only thing that's going to fix depression caused by a thyroid imbalance is to get the thyroid back in balance somehow. Some people go as far as surgery (I looked into it as that's what they thought I had).
It makes total sense you have no motivation for life. You're on three meds that take that out of you. Are you still agitated?
Posted by LostBoyinNC43 on March 1, 2013, at 23:11:38
In reply to Re: what's the best treatment for agitated depression?, posted by PrettyLady on March 1, 2013, at 21:58:17
Unipolar agitated depression?
REMERON.
Other than the weight gain it causes, I think its the best modern class antidepressant out there. No akathisia, smooth feeling, awesome for insomnia like with SSRIs or Effexor.
LostBoyinNC
Posted by SLS on March 1, 2013, at 23:56:46
In reply to Re: what's the best treatment for agitated depression?, posted by LostBoyinNC43 on March 1, 2013, at 23:11:38
> Unipolar agitated depression?
>
> REMERON.
>
> Other than the weight gain it causes, I think its the best modern class antidepressant out there. No akathisia, smooth feeling, awesome for insomnia like with SSRIs or Effexor.
>
> LostBoyinNC
If you feel worse in the mornings and have lost weight, the tricyclics are often effective. Nortriptyline is probably the mildest with regard to side effects. Imipramine is more effective statistically, but has more pronounced side effects. Just as with SSRIs, one can respond well to one TCA and not at all to another. More recently, I have seen the combining of a TCA with Remeron. I can't attest to the effectiveness of this strategy, but it is interesting.
- Scott
Posted by LostBoyinNC43 on March 6, 2013, at 11:53:34
In reply to Re: what's the best treatment for agitated depression?, posted by SLS on March 1, 2013, at 23:56:46
the best "treatment" for my "agitated" depression was getting put on CPAP therapy for obstructive sleep apnea. I calmed down to more normal levels after that happened and could sleep more normally. I think getting proper sleep is critical in all mood disorders. I dont understand why more psychiatrists do not focus on sleep disorders, in addition to just psychopharmacology.
As far as medications for "agitated" depression, like I mentioned above, Remeron was the best for me, except for the weight gain. I never took a tricyclic antidepressant that I felt was good for agitated depression. The anti-cholinergic side efffecs all TCAs have spikes your resting pulse. Remeron also blocks some of the serotonin receptors associated with agitation and akathisia and anxiety.
Eric AKA "LostBoyinNC"
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